Tt

i

Testosterone

i

i

Note: With starvation, an adaptive hormonal response is present, preserving lean mass and energy, while a maladaptive catabolic state occurs with the "stress response" activated by any wound.12,31

Note: With starvation, an adaptive hormonal response is present, preserving lean mass and energy, while a maladaptive catabolic state occurs with the "stress response" activated by any wound.12,31

required to preserve lean mass and maintain the process of wound healing. Increasing anabolic activity using hormones can increase protein synthesis.27-30

In addition, the anabolic hormones, human growth hormone and the anabolic steroids, have been shown to have anticortisol activity. This effect decreases the catabolic response of cortisol but does not alter the protective anti-inflammatory response.

It is now well recognized that the hormonal environment, so critical to wound healing, can be beneficially modified.21-30 The specific aspects of each anabolic hormone will be described in depth in subsequent sections.

In general, restoration or improvement in net protein synthesis and, therefore, in wound healing, is the result of two processes. The first is an attenuation of the catabolic hormonal response, and the second is an increase in overall anabolic activity.

Attenuation of Catabolism

Any hormonal manipulation that decreases the rate of catabolism would appear to be beneficial for wound healing. The careful use of P-blockers to attenuate the stress-induced hyperadrenergic state has been shown to significantly decrease net catabo-lism in clinical studies on burn and trauma patients.43-44 Blocking the cortisol response would seem to be intuitively beneficial, and as stated, growth hormone and testosterone analogs decrease the catabolic response to cortisol.33-37

However, any attempt to block the anti-inflammatory effects of cortisol will result in an increase in the acute destructive inflammatory response, further increasing morbidity.

Accentuation of Anabolic Activity

A number of clinical studies have demonstrated the ability of exogenous delivery of anabolic hormones to increase net nitrogen retention and overall protein synthe-sis.35-42 Wound healing has been reported to be improved. However, it remains unclear as to how much of this response is the result of an overall systemic anabolic effect, or whether there is a direct effect on wound healing. Listed in Table 14.4 are the anabolic hormones for which there are available data (animal and clinical).

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