Mechanisms of Growth Hormone & Insulin-Induced Alterations in Metabolism During Critical Illness (Acta Biomedica Lovaniensia, 302)

This is a Ph.D. dissertation. In this thesis attention will be focuses on the mechanisms by which growth hormone and insulin modify some major metabolic pathways, in light of their opposite effects on outcome of critical illness. Chapter 1 comprises a brief overview of the clinical presentation of critical illness and its endocrine aspects, together with an introduction to the insulin-like growth factor axis and liver function during critical illness. A selection of highly regarded review articles will help the reader gain insight into these matters. For reasons of conciseness original publications were left out of the introduction. A statement on the general hypothesis and the study objectives closes the introductory chapter. In Chapter 2 reports of four original, experimental studies, either published, in press or in submission, will be presented.

This chapter includes a study in which we examined the effect of growth hormone on the sepsis-induced modulation of the hepatic bile transporter system. The chapter also encompasses the studies of the effects of intensive insulin therapy on glucose and lipid metabolism during critical illness, together with its modulation of the growth hormone-dependent somatropic axis. Chapter 3 will be dedicated to a general discussion of the findings in the light of the existing literature, citing the original publications. This thesis should provide a tool to discover the fascination of endocrine disease during critical illness.