Growth hormone and multiple organ dysfunction syndrome

Multiple organ dysfunction syndrome (MODS) is associated with a marked catabolic response. Although, initially, aspects of this response are likely to be advantageous, the relentless loss of lean tissue and protein-wasting soon become functionally important, leading to increases in morbidity and mortality. Because standard nutritional support does little to limit protein-wasting in patients with MODS, investigators have sought to develop alternative treatment strategies. Amongst the many factors implicated in the adverse effects of prolonged catabolism, the role of the hypothalamic–anterior–pituitary axis has stimulated considerable research and debate. In view of the well-documented anabolic properties of growth hormone, the efficacy of treatment with recombinant human growth hormone (rhGH) has been extensively investigated in the critically ill. Results have been disappointing however, and prospective randomized controlled trials have clearly demonstrated the dangers of administering ‘pharmacological’ doses of rhGH to those with prolonged critical illness. More recently, the potential of growth hormone secretagogues, which can restore the natural pulsatility of the hypothalamic–pituitary axis, has been explored.