Which of the following are counter-regulatory hormones responsible for the hypercatabolic state observed in critically ill trauma patients?

• A. glycogen, insulin, norepinephrine
• B. glucagon, epinephrine, cortisol
• C. glycerol, serotonin, thymoglobulin
• D. glycerin, leptin, adenosine

Answer: (B)

In critical illness and trauma, the body mounts a stress response that opposes insulin to ensure quick energy substrates are available for vital tissues. The main counter-regulatory hormones driving this hypercatabolic state are glucagon, epinephrine, and cortisol. Glucagon raises hepatic glucose production through glycogenolysis and gluconeogenesis and promotes fat breakdown for energy. Epinephrine acts rapidly to mobilize glucose and fats by stimulating glycogenolysis, gluconeogenesis, and lipolysis, while also increasing muscle proteolysis to supply amino acids. Cortisol provides a longer-lasting influence by enhancing gluconeogenesis, increasing proteolysis, and promoting lipolysis, all while reducing peripheral glucose uptake and contributing to insulin resistance. The combined action of these hormones accelerates protein breakdown and substrate mobilization, which characterizes the hypercatabolic state seen in critically ill trauma patients.

Other listed substances do not fit this role. They are not the primary acute counter-regulatory hormones driving this response—glycerol and glycerin are metabolic substrates, serotonin and thymoglobulin are not central regulators of the stress-induced catabolic process, and leptin or adenosine do not mediate the same rapid, insulin-opposing catabolic drive seen in acute trauma.