SEX STEROID-HORMONES IN CIRCULATORY SHOCK, SEPSIS SYNDROME, AND SEPTIC SHOCK

Methods: Estrone (E1), estradiol (E2), testosterone (T), FSH, and LH l evels were daily measured during a ten day period in 50 critically ill patients (38 men, 12 post-menopausal women). Patients were separated into four groups: A) no circulatory failure, no sepsis, B) sepsis synd rome without circulatory failure, C) circulatory failure without sepsi s syndrome, D) septic shock. Results of hormonal measurements were com pared 1) among the 4 groups, 2) between male and female patients, 3) b etween septic and nonseptic patients. The potential for the infusion o f the vasoactive drug dobutamine to induce sex hormonal changes was do cumented in ten additional septic shock patients by measuring cortisol , E1, and T at base-line and after dobutamine infusion. Changes in act ive renin and plasma renin activity (PRA) were used as indirect witnes s of the dobutamine-induced beta 2-stimulation. Results: A dramatic in crease in E1 and E2 levels was observed in women of groups B and D, an d only in male patients of group D. In the septic patients, estrogen l evels peaked at days 1 and 2 and trended to normal from day 6 after th e onset of sepsis, while FSH and LH decreased. No difference was found between survivors and non-survivors. Whatever the group, male patient s had low T levels throughout the study. Dobutamine induced a signific ant increase in active renin levels and a decrease in the regression s lope between renin and PRA. Cortisol levels remained normal. No signif icant change in E1 and T was observed after dobutamine. Conclusions: H igh estrogen levels were specifically observed in patients with sepsis and septic shock, either males or females. Decreased LH and FSH level s were consistent with the negative feed-back effect of high estrogen levels on pituitary secretion. Circulating T levels were decreased in all male patients. We found no correlation between sequential estrogen levels and outcome. These levels were not modified by a dobutamine-in duced beta-2 stimulation. (C) 1994 Wiley-Liss, Inc.