Gonadal responses to critical illness

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Luteinizing hormone is secreted in a pulsatile fashion by the pituitary gland and stimulates testicular secretion of testosterone in men. Testosterone levels fall promptly within 24 h of the onset of severe illness, but there is no compensatory rise in gonadotropins. Instead there is a fall in levels which persists for the duration of illness. In postmenopausal women, severe illness is also associated with relatively low concentrations of gonadotropins which correlate directly with outcome. These findings are compatible with an illness-induced hypogonadal syndrome.

In men, testosterone is the most important of the endogenous anabolic steroids and various catabolic states result in low testosterone concentrations. It is interesting to speculate that the changes in gonadal steroids, unlike those observed with the thyroid hormones, reflect actual deficiency states and that the lack of testosterone/estrogen contributes to the catabolism of critical illness.

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