REPRODUCTIVE AXIS SUPPRESSION IN ACUTE ILLNESS IS RELATED TO DISEASE SEVERITY

Changes in the adrenal and thyroid axes in critically ill patients are accentuated by increasing disease severity. However, the relationship of gonadal axis suppression to severity of illness is not well define d. We evaluated serial serum levels of LH, FSH, and testosterone (T) i n 59 men and 42 postmenopausal women admitted to critical care units w ith a spectrum of disease severity. Patients were grouped according to severity of illness by the Acute Physiologic and Chronic Health Evalu ation II (APACHE II) scores and by survival. Patients with surgery, re nal or hepatic failure, alcohol abuse, endocrine disease, or head trau ma were excluded to avoid these confounding factors. In men, mean admi ssion serum T levels in all groups were lower than in healthy controls (P < 0.005). In addition, T levels in men with severe illness (APACHE > 15) were lower than in men with relatively mild (APACHE < 10; P < 0 .01) or moderate illness (APACHE 10-15; P < 0.05). These differences w ere accentuated as hospitalization progressed. In postmenopausal women and men, nadir serum FSH but not LH levels during hospitalization wer e lower in patients with APACHE greater than 15 than in patients with APACHE scores of 10-15 or less than 15 (P < 0.05). Grouping patients b y survival yielded similar results. Analysis of drug effects, age, and PRL did not explain these relationships. We conclude that the degree of both central and peripheral suppression of the reproductive axis in acute illness is related to disease severity. This suppression could not be attributed to other factors known to alter the reproductive axi s independently from critical illness (e.g. age, drugs, head trauma, h epatic failure, etc.). These findings further document a general endoc rine response to acute illness involving several axes which is graded according to disease severity.