Sexual hormone pattern in chronic critically ill patients

Introduction

The sexual hormone pattern of the chronic critically ill patient has been recently considered as one of determinants of the catabolic state that delays recovery and conditions the outcome of the disease. It is characterized by a reduction of the pituitary production of luteinizing hormone-follicle-stimulating hormone (LH-FSH) and consequently of the peripheral androgens; on the contrary, the levels of estrogens are increased due to the enhanced activity of aromatase [1]. The objective of our study was to evaluate the pattern of sexual hormone production to identify a correct replacement therapy.

Methods

Thirteen men with chronic critical illness with a mean age of 70 years and a mean APACHE score of 18 have been enrolled. Patients with endocrinological pathologies or in therapy with hormones, cortisones or dopamine have been excluded. The analysis of the sexual endocrine function was determined on the seventh day of stay in the ICU, considering the mean of four nocturnal measurements of LH-FSH, androstenedione, dehydroepiandrosterone sulfate, testosterone and estradiol.

Results

Only three patients showed a reduction of LH-FSH under normal levels, 10 patients had normal levels of LH-FSH. All 13 patients had normal or elevated levels of androstendione, a precursor of testosterone. Levels of testosterone and dehydroepiandrosterone sulfate were decreased under normal levels in all patients. Levels of estrogens were elevated above normal levels in all patients.

Conclusion

The present study shows that in the early phase of chronic critical illness the reduction of testosterone could only partially be determined by the decreased pituitary stimulation. The normal levels of androstenedione, a precursor of testosterone, suggest an impairment of the intracellular pathway of androgen production through an inhibition of the 17β-hydroxysteroido-dehydrogenase. Considering these results, an exogenous stimulation of testosterone production with LH-FSH secretagogues could be unisexual or not sufficient to rebalance the testosterone levels [2]. Furthermore, the increased conversion of peripheral androgens in estrogens mediated by aromatase is confirmed in this study. The use of aromatase inhibitors could be considered as a therapeutic way to rebalance the hormone axes in critical illness.