What is Human Growth Hormone?
Growth hormone is an essential hormone produced by the pituitary gland. In normal people, the production is highest during infancy and childhood with occasional boosts in the production of HGH associated with growth spurts. Growth hormone stimulates lipolysis and protein synthesis. Until a few years ago, growth hormones could only be obtained by directly extracting it from the pituitary gland. There are many supplements available on the market which claims to boost the production of growth hormones. More recently, recombinant growth hormone has been made available through genetic engineering.
Multiple studies have been conducted which review the efficacy of growth hormone therapy in burn patients with extensive burn injury. In order to understand the role of growth hormones in burn treatment, it is essential to understand the metabolic changes that occur while healing from a burn.
Metabolic Changes That Occur In Burn Victims
In burn victims with a total burn surface area greater than 40%, there is systemic involvement of the whole body resulting in a hypermetabolic state. The hypermetabolic response is described by a hyperdynamic circulatory response, increased body temperature; increased oxygen and glucose consumption; increased carbon dioxide production; raised blood sugar levels, peripheral insulin resistance, increased breakdown of glycogen, protein, and lipids with loss of lean body mass; and muscle and bone wasting.
The resting metabolic rate rises significantly and the body derives the required energy by breaking down proteins. This breakdown of tissues for use as energy is known as catabolism. In burn victims, catabolism occurs at a higher rate to provide energy for the hypermetabolic state. However, the rate of catabolism is insufficient and results in muscle wasting as well as delayed wound healing.
How Can Growth Hormone Therapy Help?
A recommended anabolic therapy to counter the catabolic state in burn injury is growth hormone therapy. As growth hormone promotes protein synthesis and fat metabolism, it has the potential to produce these similar effects in burn victims as well.
Multiple Studies On The Role Of HGH In Burn Victims
1. Recombinant Human Growth Hormone For Treating Burns And Donor Sites
Objective: To determine the effects of rhGH on the healing rate of burn wounds and donor sites in people with burns.
Participants: 13 Randomized controlled trials (701 people)
Methodology: Randomized controlled trials (RCTs) comparing rhGH with any comparator intervention, e.g. oxandrolone or placebo, in adults or children with burns.
The mean TBSA of the included participants was greater than 49%. Twelve studies compared rhGH with placebo and one study compared rhGH with oxandrolone. Two trials found that compared with placebo, burn wounds in adults treated with rhGH healed more quickly (by 9.07 days; 95% confidence interval (CI) 4.39 to 13.76, I² = 0%). The donor site healing time was significantly shorter in rhGH‐treated adults compared with placebo‐treated participants (by 3.15 days; 95% CI 1.54 to 4.75, I² = 0%). Two studies in children with the outcome of donor site healing time could be pooled and the donor site healing time was shorter in the rhGH‐treated children (by 1.70 days; 95% CI 0.87 to 2.53, I² = 0%).
The study found some evidence that recombinant growth hormone therapy in people with burns covering more than 40% of the total body surface area helps burn wounds and donor sites heal more rapidly thus reducing the length of stay in the hospital.
2. Effect Of Growth Hormone Therapy In Burn Patients On Conservative Treatment.
Objective: To evaluate the efficacy of HGH therapy in burn victims
Participants: 22 patients with second and third-degree burns
Methodology: Serial observations on the clinical and biochemical profiles in 13 patients with second and third-degree burns who received recombinant human growth hormone (rhGH) (0.5 IU/kg body wt) for 2 weeks in addition to standard conservative treatment and in 9 patients who were managed with standard conservative treatment only.
Additional rhGH treatment resulted in improved wound healing, delayed separation of eschars, an increase in hemoglobin, serum albumin, calcium), phosphorus, glomerular filtration rate and 7 fold elevation in IGF-1. Also, a reduction in weight loss, nitrogen production rate, catabolic index, duration of sepsis and hospital stay by 40% was noted with rhGH therapy. Transient hypercalcemia (3 patients), albuminuria (2 patients) and elevated blood glucose (one patient) were noted in the rhGH treated group not necessitating any specific therapy. Mortality in the rhGH treatment group was 8.3% compared to 44.5% in the “no rhGH” treatment group.
The findings from the study suggested significant benefits of short term rhGH treatment in burn patients on conservative management.
Many types of research have implicated the safety and efficacy of growth hormone therapy in burn victims. It not only accelerates wound healing in burns, but it also prevents muscle wasting while simultaneously reducing mortality. Getting FDA approval with detailed and accurate randomized clinical trials to initiate Human Growth Hormone therapy in burn victims should be the next step.