Recombinant human methionyl
growth hormone (
Protropin) (Genetech, Inc., San Francisco, CA) administered to normal volunteers receiving hypocaloric
parenteral nutrition minimized
weight loss and induced positive
nitrogen balance. To evaluate whether
growth hormone (GH) can promote anabolism in surgical patients, 11 stable malnourished individuals were studied. In the initial trial, subjects received a constant
parenteral infusion of a hypocaloric diet that provided approximately 1100 kcal/24 hr and 1.3
g protein/kg/24 hr for at least 2 weeks. During 1 week, GH 10 mg was given subcutaneously daily, whereas the other week served as the control. Daily balance studies demonstrated that administration of GH resulted in significant retention of
nitrogen (+3.4 g/24 h) and
phosphorus (+218 mg/24 h), despite provision of only 60% of caloric requirements. With GH, serum blood
urea nitrogen (BUN) and
potassium fell, whereas
glucose and
insulin tended to rise, and levels of
insulin-like growth factor 1 increased three to fourfold.
Weight gain occurred with GH and was associated with positive
mineral and water balance. Six patients received GH (10 mg subcutaneously daily) for 13-25 consecutive days after an initial control week. Significant
nitrogen and
phosphorus retention occurred over the entire period of GH administration, and no significant side effects were observed. In these depleted patients, GH caused significant and sustained
nitrogen retention over a wide range of
nutritional support. GH appears to enhance the efficacy of
parenteral nutrition in stable individuals requiring repletion of body
protein.