Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1984 Sep;200(3):264–281. doi: 10.1097/00000658-198409000-00004

Combined hormonal infusion simulates the metabolic response to injury.

P Q Bessey, J M Watters, T T Aoki, D W Wilmore
PMCID: PMC1250469  PMID: 6431917

Abstract

To investigate the role of hormones as mediators of the metabolic response to injury, nine normal male volunteers received a continuous 74-hour infusion of the three 'stress' hormones: cortisol, glucagon, and epinephrine. As a control, each subject received a saline infusion during another 4-day period. Diets were constant and matched on both occasions. Hormonal infusion achieved hormone concentrations similar to those seen following mild-moderate injury. With this alteration in the endocrine environment significant hypermetabolism, negative nitrogen and potassium balances, glucose intolerance, hyperinsulinemia, insulin resistance, sodium retention, and peripheral leukocytosis were observed. Additional studies with single hormone infusions indicated that these responses resulted from both additive and synergistic interactions of the hormones. Triple hormone infusion simulated many of the metabolic responses observed following mild-moderate injury and other catabolic illnesses.

Full text

PDF
264

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alberti K. G., Batstone G. F., Foster K. J., Johnston D. G. Relative role of various hormones in mediating the metabolic response to injury. JPEN J Parenter Enteral Nutr. 1980 Mar-Apr;4(2):141–146. doi: 10.1177/014860718000400214. [DOI] [PubMed] [Google Scholar]
  2. Allison S. P., Hinton P., Chamberlain M. J. Intravenous glucose-tolerance, insulin, and free-fatty-acid levels in burned patients. Lancet. 1968 Nov 23;2(7578):1113–1116. doi: 10.1016/s0140-6736(68)91581-x. [DOI] [PubMed] [Google Scholar]
  3. Aoki T. T., Brennan M. F., Fitzpatrick G. F., Knight D. C. Leucine meal increases glutamine and total nitrogen release from forearm muscle. J Clin Invest. 1981 Dec;68(6):1522–1528. doi: 10.1172/JCI110406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Baracos V., Rodemann H. P., Dinarello C. A., Goldberg A. L. Stimulation of muscle protein degradation and prostaglandin E2 release by leukocytic pyrogen (interleukin-1). A mechanism for the increased degradation of muscle proteins during fever. N Engl J Med. 1983 Mar 10;308(10):553–558. doi: 10.1056/NEJM198303103081002. [DOI] [PubMed] [Google Scholar]
  5. Becker R. A., Vaughan G. M., Goodwin C. W., Jr, Ziegler M. G., Harrison T. S., Mason A. D., Jr, Pruitt B. A. Plasma norepinephrine, epinephrine, and thyroid hormone interactions in severely burned patients. Arch Surg. 1980 Apr;115(4):439–443. doi: 10.1001/archsurg.1980.01380040067012. [DOI] [PubMed] [Google Scholar]
  6. Becker R. A., Wilmore D. W., Goodwin C. W., Jr, Zitzka C. A., Wartofsky L., Burman K. D., Mason A. D., Pruitt B. A. Free T4, free T3, and reverse T3 in critically ill, thermally injured patients. J Trauma. 1980 Sep;20(9):713–721. doi: 10.1097/00005373-198009000-00001. [DOI] [PubMed] [Google Scholar]
  7. Beisel W. R., Sawyer W. D., Ryll E. D., Crozier D. Metabolic effects of intracellular infections in man. Ann Intern Med. 1967 Oct;67(4):744–779. doi: 10.7326/0003-4819-67-4-744. [DOI] [PubMed] [Google Scholar]
  8. Bessey P. Q., Brooks D. C., Black P. R., Aoki T. T., Wilmore D. W. Epinephrine acutely mediates skeletal muscle insulin resistance. Surgery. 1983 Aug;94(2):172–179. [PubMed] [Google Scholar]
  9. Black P. R., Brooks D. C., Bessey P. Q., Wolfe R. R., Wilmore D. W. Mechanisms of insulin resistance following injury. Ann Surg. 1982 Oct;196(4):420–435. doi: 10.1097/00000658-198210000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Blackard W. G., Nelson N. C., Andrews S. S. Portal and peripheral vein immunoreactive glucagon concentrations after arginine or glucose infusions. Diabetes. 1974 Mar;23(3):199–202. doi: 10.2337/diab.23.3.199. [DOI] [PubMed] [Google Scholar]
  11. Clowes G. H., Jr, George B. C., Villee C. A., Jr, Saravis C. A. Muscle proteolysis induced by a circulating peptide in patients with sepsis or trauma. N Engl J Med. 1983 Mar 10;308(10):545–552. doi: 10.1056/NEJM198303103081001. [DOI] [PubMed] [Google Scholar]
  12. Davies C. L., Newman R. J., Molyneux S. G., Grahame-Smith D. G. The relationship between plasma catecholamines and severity of injury in man. J Trauma. 1984 Feb;24(2):99–105. doi: 10.1097/00005373-198402000-00002. [DOI] [PubMed] [Google Scholar]
  13. DeFronzo R. A., Tobin J. D., Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol. 1979 Sep;237(3):E214–E223. doi: 10.1152/ajpendo.1979.237.3.E214. [DOI] [PubMed] [Google Scholar]
  14. Felig P., Gusberg R., Hendler R., Gump F. E., Kinney J. M., Mulrow P. J. Concentrations of glucagon and the insulin:glucagon ratio in the portal and peripheral circulation. Proc Soc Exp Biol Med. 1974 Oct;147(1):88–90. doi: 10.3181/00379727-147-38286. [DOI] [PubMed] [Google Scholar]
  15. HUME D. M., NELSON D. H., MILLER D. W. Blood and urinary 17-hydroxycorticosteroids in patients with severe burns. Ann Surg. 1956 Mar;143(3):316–329. doi: 10.1097/00000658-195603000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Harrison T. S., Seaton J. F., Feller I. Relationship of increased oxygen consumption to catecholamine excretion in thermal burns. Ann Surg. 1967 Feb;165(2):169–172. doi: 10.1097/00000658-196702000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hjemdahl P., Belfrage E., Daleskog M. Vascular and metabolic effects of circulating epinephrine and norepinephrine. Concentration-effect study in dogs. J Clin Invest. 1979 Nov;64(5):1221–1228. doi: 10.1172/JCI109576. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Juan C., AvRuskin T. W. A combined immunoassay of human growth hormone and insulin: cumulative assessment of assay performance. J Clin Endocrinol Metab. 1971 Jul;33(1):150–152. doi: 10.1210/jcem-33-1-150. [DOI] [PubMed] [Google Scholar]
  19. Jättelä A., Alho A., Avikainen V., Karaharju E., Kataja J., Lahdensuu M., Lepistö P., Rokkanen P., Tervo T. Plasma catecholamines in severely injured patients: a prospective study on 45 patients with multiple injuries. Br J Surg. 1975 Mar;62(3):177–181. doi: 10.1002/bjs.1800620303. [DOI] [PubMed] [Google Scholar]
  20. Nonaka K., Foà P. P. A simplified glucagon immunoassay and its use in a study of incubated pancreatic islets. Proc Soc Exp Biol Med. 1969 Jan;130(1):330–336. doi: 10.3181/00379727-130-33549. [DOI] [PubMed] [Google Scholar]
  21. Owen O. E., Cahill G. F., Jr Metabolic effects of exogenous glucocorticoids in fasted man. J Clin Invest. 1973 Oct;52(10):2596–2605. doi: 10.1172/JCI107452. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. PARSON W., CRISPELL K. R., EBBERT A., Jr Abnormalities in N15 excretion rates after ingestion of tagged glycine in Cushing's syndrome and following ACTH administration. J Clin Invest. 1952 Jun;31(6):548–554. doi: 10.1172/JCI102640. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Peuler J. D., Johnson G. A. Simultaneous single isotope radioenzymatic assay of plasma norepinephrine, epinephrine and dopamine. Life Sci. 1977 Sep 1;21(5):625–636. doi: 10.1016/0024-3205(77)90070-4. [DOI] [PubMed] [Google Scholar]
  24. Picou D., Taylor-Roberts T. The measurement of total protein synthesis and catabolism and nitrogen turnover in infants in different nutritional states and receiving different amounts of dietary protein. Clin Sci. 1969 Apr;36(2):283–296. [PubMed] [Google Scholar]
  25. Press M., Tamborlane W. V., Sherwin R. S. Importance of raised growth hormone levels in mediating the metabolic derangements of diabetes. N Engl J Med. 1984 Mar 29;310(13):810–815. doi: 10.1056/NEJM198403293101302. [DOI] [PubMed] [Google Scholar]
  26. Roth J., Glick S. M., Cuatrecasas P., Hollander C. S. Acromegaly and other disorders of growth hormone secretion. Combined clinical staff conference at the National Institutes of Health. Ann Intern Med. 1967 Apr;66(4):760–788. doi: 10.7326/0003-4819-66-4-760. [DOI] [PubMed] [Google Scholar]
  27. Soeldner J. S., Slone D. Critical variables in the radioimmunoassay of serum insulin using the double antibody technic. Diabetes. 1965 Dec;14(12):771–779. doi: 10.2337/diab.14.12.771. [DOI] [PubMed] [Google Scholar]
  28. Stoner H. B., Barton R. N., Little R. A., Yates D. W. Measuring the severity of injury. Br Med J. 1977 Nov 12;2(6097):1247–1249. doi: 10.1136/bmj.2.6097.1247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Vaughan G. M., Becker R. A., Allen J. P., Goodwin C. W., Jr, Pruitt B. A., Jr, Mason A. D., Jr Cortisol and corticotrophin in burned patients. J Trauma. 1982 Apr;22(4):263–273. doi: 10.1097/00005373-198204000-00001. [DOI] [PubMed] [Google Scholar]
  30. Wannemacher R. W., Jr, Pekarek R. S., Thompson W. L., Curnow R. T., Beall F. A., Zenser T. V., DeRubertis F. R., Beisel W. R. A protein from polymorphonuclear leukocytes (LEM) which affects the rate of hepatic amino acid transport and synthesis of acute-phase globulins. Endocrinology. 1975 Mar;96(3):651–661. doi: 10.1210/endo-96-3-651. [DOI] [PubMed] [Google Scholar]
  31. Wilmore D. W., Lindsey C. A., Moyland J. A., Faloona G. R., Pruitt B. A., Unger R. H. Hyperglucagonaemia after burns. Lancet. 1974 Jan 19;1(7847):73–75. doi: 10.1016/s0140-6736(74)92290-9. [DOI] [PubMed] [Google Scholar]
  32. Wilmore D. W., Long J. M., Mason A. D., Jr, Skreen R. W., Pruitt B. A., Jr Catecholamines: mediator of the hypermetabolic response to thermal injury. Ann Surg. 1974 Oct;180(4):653–669. doi: 10.1097/00000658-197410000-00031. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Wilmore D. W., Long J. M., Mason A. D., Pruitt B. A., Jr Stress in surgical patients as a neurophysiologic reflex response. Surg Gynecol Obstet. 1976 Feb;142(2):257–269. [PubMed] [Google Scholar]
  34. Wolfe B. M., Culebras J. M., Aoki T. T., O'Connor N. E., Finley R. J., Kaczowka A., Moore F. D. The effects of glucagon on protein metabolism in normal man. Surgery. 1979 Aug;86(2):248–257. [PubMed] [Google Scholar]
  35. Wolfe R. R., Allsop J. R., Burke J. F. Glucose metabolism in man: responses to intravenous glucose infusion. Metabolism. 1979 Mar;28(3):210–220. doi: 10.1016/0026-0495(79)90066-0. [DOI] [PubMed] [Google Scholar]
  36. Wolfe R. R., Durkot M. J., Allsop J. R., Burke J. F. Glucose metabolism in severely burned patients. Metabolism. 1979 Oct;28(10):1031–1039. doi: 10.1016/0026-0495(79)90007-6. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES