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Inflammatory cytokines have little or no effect on GH-mediated JAK-STAT signalling : secondary changes in the structure of chromatin are likely to be involved in the induction of IGF-I gene transcription by GH.

In critical illness, serum concentrations of the growth hormone-dependent complexes containing IGF-I and IGF-II are decreased.

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This is initially due to a transient GH resistance, but in the longer term, the less pulsatile pattern of GH secretion may be a major factor since only pulsatile growth hormone increases the levels of IGF-I and the acid-labile subunit.

Other factors contributing to a low IGF level are nutritional deficiency and the direct effects of inflammatory cytokines.

Overall there is a reduction in the indirect IGF-I-mediated anabolic actions of GH and an increase in the direct catabolic actions of GH.

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