Suppression of Gonadotropin Secretion in the Hospitalized Postmenopausal Female as an Effect of Acute Critical Illness

Abstract

Plasma gonadotropins were measured in 126 postmenopausal women (age range 69–90 years) admitted to a geriatric ward. After clinical examination, patients were classified as ‘acutely or severely ill’ or as ‘not ill’. Plasma gonadotropins were compared between both groups. Logistic regression was used to select clinical and/or biochemical parameters which differentiated patients with abnormal, low gonadotropins from patients with high gonadotropin concentrations. Plasma gonadotropins were significantly lower in the ‘acutely or severely ill’ than in the ‘healthy’ patient group. By logistic regression, blood sedimentation rate, total protein concentration, and serum thyrotropin concentration were significantly correlated with low gonadotropins. Linear regression analysis showed a significant linear relationship between plasma gonadotropins and age (at least for ages over 80 years), blood sedimentation rate (at values more than 65 mm) and total protein concentration. Marked suppression of plasma gonadotropins was frequently found to occur in acutely ill postmenopausal women, in relation to biochemical parameters of acute illness such as blood sedimentation rate, total protein concentration, and serum thyrotropin. In addition, ageing per se seems characterized by a progressive attenuation of the high postmenopausal gonadotropin levels.

The pıtuıtary-gonadal-thyroıd and lactotroph axes ın crıtıcally ıll patıents

“…As demonstrated in our patients, LH and FSH levels decrease in severely ill women [4,6,9,14]. The decrease was not dependent on disease type, patient's age, and medications used [5,14].…”

“…A decline in gonadotropins occurred within 24 hours of an acute insult and continued until the nadir decline in 4-6 days, as in the present study [4,14]. As the disease becomes more severe, so the hormonal suppression gets worse, with very low LH (£ 0.5 mlU/mL) and FSH (£ 1 mlU/mL) [9,14]. We observed severely depressed values with LH £ 1.0 mIU/mL in four and FSH ≤ 5.0 mIU/mL in three women on admission, and even lower LH (£ 0.5 mlU/ /mL) and FSH (≤ 1 mlU/mL) levels in three and one patient/s, respectively, during ICU stay.…”

“…Suppressed hormones rebound with disease improvement [9,10,20]. In our patients, discharged female patients had a significant increase in FSH levels.…”

“…In the chronic phase, T decreases further and gonadotropins are measured low, supporting hypothalamic-pituitary dysfunction [7,8]. Similar alterations in LH and FSH values are encountered in women [4,6,9,10].…”

“…Since LH is more severely affected than FSH, the rise in FSH occurs first during recovery [6,20]. Return of gonadotropins to normal limits was reported to take months, even years in some patients [6,9,10]. Since we did not have serial hormone measurements after ICU discharge, we could not say anything about the return of gonadotropins to normal limits.…”