Hormonal changes in catabolic patients during parenteral nutrition

Abstract

This study assesses the hormonal changes in 23 catabolic surgical patients during the three different regimens of parenteral nutrition: one with glucose, another with glucose and fat as energy sources, and a third one rich in amino acids. Before treatment, plasma insulin and cortisol concentrations, as well as daily urinary excretion of 17-oxogenic steroids and catecholamines, were normal. Plasma growth hormone concentration was close to normal. Plasma testosterone and daily urinary excretion of 17-oxosteroids were decreased. The response of plasma cortisol concentration to glucagon was impaired but the responses of insulin and growth hormone were close to normal. During the glucose regimen plasma insulin increased by 270% and plasma testosterone by 60%. There was a 55% decrease in plasma growth hormone concentration and a 31% rise in plasma cortisol concentration. The lipid regimen enhanced plasma insulin by 120%. During the amino acid regimen plasma insulin concentration was 150% higher, but plasma growth hormone concentration 45% lower than initially. The glucose and amino acid regimens augmented the response of insulin to glucagon by 180 and 50%, respectively, but decreased that of growth hormone by 59 and 80%, respectively. The lipid programme caused no significant change in the hormonal response to glucagon.