Serum testosterone, follicle-stimulating hormone, luteinising hormone, and dihydroepiandrosterone concentrations rose significantly in seven men studied during recovery from a severe exacerbation of chronic obstructive airways disease. Urinary 17-ketosteroids also rose significantly though serum androstenedione and prolactin concentrations did not. Our findings suggest that hypoxia in this condition suppresses the hypothalamus or pituitary or both and that such suppression is reversible. In view of previous reports of increase in total body potassium and intracellular water with recovery from cor pulmonale, we also carried out metabolic studies on our patients. Low body potassium concentrations in cor pulmonale fell further with recovery, in part reflecting a fall in lean body tissue. Intracellular water appeared to increase on recovery despite a fall in other lean body mass indices (the simplest and most reliable being skinfold thickness). We suspect this result to be spurious and due to problems with equilibration in isotope dilution. Alternatively it may reflect waterlogging of cells. A false figure for intracellular water could be responsible for an unexpectedly low estimated intracellular potassium concentration on recovery. Our results cast doubt on isotope dilution methods for measuring body water compartments in disease states likely to cause changes in cell permeability.In a previous paper comparing underweight normocapnic "pink puffers" with overweight hypercapnic "blue bloaters"' we showed no difference between them in calorie intake, thyroid function:, or corticosteroid production to explain differences in body build, and moreover showed that pink puffers had negative results in malabsorption studies. Serum testosterone, however, was profoundly reduced in blue bloaters and somewhat reduced in pink puffers, while blue bloaters had rather higher serum prolactin levels. Further studies showed a correlation between severity of hypoxia and degree of testosterone suppression.2 This testosterone reduction was apparently caused by hypoxic suppression of the hypothalamus or pituitary,3 and sexual impotence was a feature.4 We also considered that such endocrine disturbances might cause changes in body habitus in chronic obstructive airways disease.' The weight loss and depressed gonadal function which occur at high altitude56 might be similarly associated.
