Journal of Clinical Endocrinology & Metabolism, Vol 75, 1562-1570, Copyright © 1992 by Endocrine Society

ARTICLES

Both hyper- and hypogonadotropic hypogonadism occur transiently in acute illness: bio- and immunoactive gonadotropins

DI Spratt, ST Bigos, I Beitins, P Cox, C Longcope and J Orav
Department of Medicine, Maine Medical Center, Portland 04102.

Previous reports of hypogonadotropic hypogonadism in critically ill men may not reflect the complexity of changes in the hypothalamic-pituitary- gonadal (HPG) axis during acute illness. We sampled blood throughout hospitalization in 55 men admitted to acute care units to delineate the spectrum of changes in circulating gonadotropin and sex steroid levels at the onset and during recovery from acute illness. Bioactive LH and FSH were measured in a subset of patients. Percent free testosterone was measured to assess changes in binding to sex hormone binding globulin. Medications and serum estrogen and prolactin levels were monitored as potential causes of hypogonadotropism. Sustained suppression of serum testosterone levels below the normal range occurred in 62% of men with varying diagnoses and disease severity. Percent free testosterone remained constant. Hypogonadotropism was observed in most men (60%) and occurred independently from head injury, surgery, medications, or hyperprolactinemia. In a subset of men (n = 16), LH and/or FSH rose transiently above the normal range. Bioactivity of both LH and FSH remained constant while serum testosterone levels decreased. In contrast to serum testosterone levels, mean serum levels of E1, E2 and androstenedione were not less than control values. We conclude that both primary and secondary hypogonadism occur transiently in acutely ill men and cannot be explained solely by medications, hyperprolactinemia, or hyperestrogenemia. Neither biopotency of gonadotropins nor binding of testosterone to SHBG change across the course of acute illness. The hypogonadism, often severe and prolonged, may contribute to the persistent catabolic state observed in many critically ill patients.

This article has been cited by other articles:

				J. L. Sperry and J. P. Minei Gender dimorphism following injury: making the connection from bench to bedside J. Leukoc. Biol., March 1, 2008; 83(3): 499 - 506. [Abstract] [Full Text] [PDF]

				M. S. Rothman, D. B. Arciniegas, C. M. Filley, and M. E. Wierman The Neuroendocrine Effects of Traumatic Brain Injury J Neuropsychiatry Clin Neurosci, November 1, 2007; 19(4): 363 - 372. [Abstract] [Full Text] [PDF]

				D. I. Spratt, M. Frohnauer, H. Cyr-Alves, R. S. Kramer, F. L. Lucas, J. R. Morton, D. F. Cox, K. Becker, and J. T. Devlin Physiological effects of nonthyroidal illness syndrome in patients after cardiac surgery Am J Physiol Endocrinol Metab, July 1, 2007; 293(1): E310 - E315. [Abstract] [Full Text] [PDF]

				D. I. Spratt, J. R. Morton, R. S. Kramer, S. W. Mayo, C. Longcope, and C. P. H. Vary Increases in serum estrogen levels during major illness are caused by increased peripheral aromatization Am J Physiol Endocrinol Metab, September 1, 2006; 291(3): E631 - E638. [Abstract] [Full Text] [PDF]

				J. M. Kaufman and A. Vermeulen The Decline of Androgen Levels in Elderly Men and Its Clinical and Therapeutic Implications Endocr. Rev., October 1, 2005; 26(6): 833 - 876. [Abstract] [Full Text] [PDF]

				C. Oktenli, L. Doganci, T. Ozgurtas, R.E. Araz, M. Tanyuksel, U. Musabak, S.Y. Sanisoglu, Z. Yesilova, M.K. Erbil, and A. Inal Transient hypogonadotrophic hypogonadism in males with acute toxoplasmosis: suppressive effect of interleukin-1{beta} on the secretion of GnRH Hum. Reprod., April 1, 2004; 19(4): 859 - 866. [Abstract] [Full Text] [PDF]

				N. Pitteloud, J. Villegas, A. A. Dwyer, W. F. Crowley Jr., M. J. McPhaul, and F. J. Hayes Acute Stress Masking the Biochemical Phenotype of Partial Androgen Insensitivity Syndrome in a Patient with a Novel Mutation in the Androgen Receptor J. Clin. Endocrinol. Metab., March 1, 2004; 89(3): 1053 - 1058. [Abstract] [Full Text] [PDF]

				G. Van den Berghe, F. Weekers, R. C. Baxter, P. Wouters, A. Iranmanesh, R. Bouillon, and J. D. Veldhuis Five-Day Pulsatile Gonadotropin-Releasing Hormone Administration Unveils Combined Hypothalamic-Pituitary-Gonadal Defects Underlying Profound Hypoandrogenism in Men with Prolonged Critical Illness J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 3217 - 3226. [Abstract] [Full Text] [PDF]

				L. J. De Groot Dangerous Dogmas in Medicine: The Nonthyroidal Illness Syndrome J. Clin. Endocrinol. Metab., January 1, 1999; 84(1): 151 - 164. [Full Text]