Gonadotropin deficiency

Gonadotropin deficiency may be part of the clinical syndrome of pan-hypopituitarism or it may be isolated ( TÜoiD§L®Lal 1992). Impaired ovarian function in women and suppressed testicular function in men influence fertility and metabolism. Testosterone deficiency in men, a result of deficient luteinizing hormone secretion, is relevant to critical care medicine as testosterone is the most important of the endogenous anabolic steroids, and a decrease of its availability in men results in a negative nitrogen balance that can be restored by testosterone supplementation.

In prolonged critical illness, low luteinizing hormone levels and a profound hypoandrogenemia are consistently present. Infusion of dopamine, and to a lesser extent of opioids also, tends to blunt the secretion of luteinizing hormone further. Iatrogenic suppression of the male gonadal axis may delay recovery by blocking one of the endogenous pathways to anabolism.

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