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

Abstract

Introduction: The normal circadian rhythm of hormones in critical patients becomes chaotic causing some hormones to increase and others to decrease abnormally. The goal of this study is to evaluate hormonal changes in severely ill patients and to investigate the relationship between hormonal changes and mortality and morbidity. Material and methods: We enrolled 20 patients (10 F/10 M). Blood samples were collected on day 0, day 5, and day 10. If a patient was discharged before these defined days, a sample was drawn on that day. Twenty healthy controls were included. Results: Female patients had lower LH, FSH, and fT 3 and higher PRL and cortisol levels than controls on admission to the intensive care unit (ICU) (p LH = 0.021, p FSH :0.001, p fT3 = 0.021, p PRL = 0.042, p Cortisol < 0.001, respectively). Men had significantly low testosterone and fT 3 , and high PRL and cortisol levels on ICU admission (p T = 0.01, p fT3 = 0.043, p PRL = 0.005, p Cortisol < 0.001, respectively). The lowest levels of gonadotropins in both genders and testosterone in men were measured on day 5. Cortisol levels decreased in the patients discharged from the ICU (p = 0.01). FSH levels increased in recovered women (p FSH = 0.043). The mortality rate was 30%. There were correlations between admission TSH and NIMV duration (p = 0.006), fT 3 and APACHE II (p = 0.001), and PRL and mortality (p = 0.044). Positive correlations between E 2 and APACHE II (p = 0.003) in females, and PRL and APACHE II (p = 0.022) in males were also displayed.

Why does COVID‐19 kill more elderly men than women? Is there a role for testosterone?

“…Half of the ARDS patients died, and elderly patients were more likely to develop ARDS. Critical illnesses, like ARDS, are associated with neuroendocrine changes linked to increased morbidity and mortality 76 . Critical illnesses progress in two steps, the acute (hours to days) and chronic (weeks) stages.…”

“…Critical illnesses progress in two steps, the acute (hours to days) and chronic (weeks) stages. Cytokines are thought to be responsible for early response changes, and other endogenous (eg, dopamine, cortisol) and exogenous (eg, medications) factors contribute to the chronic changes 76,77 . During the early phase, T levels decrease and continue to decline during the chronic phase.…”

“…Critical illnesses, like ARDS, are associated with neuroendocrine changes linked to increased morbidity and mortality. 76 Critical illnesses progress in two steps, the acute (hours to days) and chronic (weeks) stages. Cytokines are thought to be responsible for early response changes, and other endogenous (eg, dopamine, cortisol) and exogenous (eg, medications) factors contribute to the chronic changes.…”

“…Cytokines are thought to be responsible for early response changes, and other endogenous (eg, dopamine, cortisol) and exogenous (eg, medications) factors contribute to the chronic changes. 76,77 During the early phase, T levels decrease and continue to decline during the chronic phase. T reduction seems to be independent of LH levels, indicating a dysfunction of the hypothalamic-pituitary-gonadal axis.…”

Serum testosterone depression as a factor influencing the general condition in chronic obstructive pulmonary disease patients

“…34 In medical practice, we should remember that critically ill patients develop significant changes in neuroendocrine axes, including changes in testosterone concentration. 35 The question is the impact of testosterone supplementation therapy on COPD patients. Atlantis et al conducted a meta-analysis of 9 observational studies and concluded that testosterone therapy improves exercise capacity.…”