Is the Use of Growth hormone and Melatonin Justified in Spinal Cord Injuries?

Spinal cord injury (SCI) is a devastating injury that leads to the total or partial loss of motor and sensory functions, but also affects the function of many body systems producing an almost total dependence and poor quality of life [1], although the level of the spinal cord in which the injury occurs and the degree of the injury are strong determinants of morbidity associated with the lesion. According to data provided by WHO in 2013, about 500.000 people worldwide suffer a SCI every year [2], most of them because of a spinal cord trauma, although vascular infarctions of the vertebral arteries are also a common cause. Most of the studies performed in patients with SCI analyze cardiovascular risk, due to increased plasma LDL cholesterol and decreased HDL cholesterol [3-7], increased obesity and oral carbohydrate intolerance and insulin resistance which leads to a high prevalence of diabetes mellitus in SCI [5,8]; other studies in SCI analyze the degree of osteoporosis, which our group observed in 88.4% of the 43 patients before being treated at our Medical Center [9], resulting in a high risk of fractures of the head of the femur when receiving physiotherapy or associated with robotic treadmill training. Since 1978, many other studies analyze the existence of orthostatic hypotension in SCI patients [10-12], although the appearance of this low blood pressure depends on the level of the spinal cord in which the injury occurred. This orthostatic hypotension mainly occurs in SCI patients with injuries above T6 (Figures 1 & 2), because of the impaired sympathetic control of the cardiovascular system, and is higher in patients with cervical lesions in which plasma levels of catecholamines are lower than in thoracic SCI patients [11].