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Adrenal androgens and illness.

C G Semple1, C E Gray, G H Beastall

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|September 1, 1987
PubMed
Summary
This summary is machine-generated.

Illness affects adrenal androgen levels. Acutely ill patients show increased androstenedione, while chronically ill patients have lower dehydroepiandrosterone sulfate (DHAS). Surgery and burns also impact DHAS, suggesting a shift towards cortisol production during critical illness.

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Area of Science:

  • Endocrinology
  • Metabolic Medicine
  • Critical Care Medicine

Background:

  • Adrenal androgens play crucial roles in various physiological processes.
  • The impact of acute and chronic illness, surgical stress, and severe injury on adrenal androgen status is not fully understood.
  • Understanding these changes is vital for managing patient health during critical conditions.

Purpose of the Study:

  • To investigate the alterations in adrenal androgen levels (androstenedione and dehydroepiandrosterone sulfate [DHAS]) in medically ill patients.
  • To examine the changes in these hormones following cholecystectomy and during recovery from burns injury.
  • To elucidate the relationship between illness severity, surgical stress, injury, and adrenal androgen metabolism.

Main Methods:

  • Serum concentrations of androstenedione, dehydroepiandrosterone sulfate (DHAS), and cortisol were measured.
  • Patients included those with acute illness (<2 weeks), chronic illness (>2 weeks), pre- and post-cholecystectomy, and burn injury.
  • Comparisons were made against control groups and across different time points during illness and recovery.

Main Results:

  • Acutely ill patients (<2 weeks) exhibited elevated serum androstenedione compared to controls and chronically ill patients.
  • Chronically ill patients (>2 weeks) showed significantly lower serum DHAS levels than acutely ill and control groups.
  • Post-cholecystectomy patients experienced a significant drop in serum DHAS, reaching a nadir on day 8.
  • Burned patients presented with increased cortisol and androstenedione on admission, while DHAS levels initially similar to controls, fell significantly by week 3.
  • These findings suggest a diversion of steroid synthesis from adrenal androgens to corticosteroids during critical illness.

Conclusions:

  • Illness significantly alters adrenal androgen status, with distinct patterns observed in acute versus chronic conditions.
  • Surgical stress and severe burns lead to profound changes in DHAS levels, indicating a catabolic response.
  • The observed hormonal shifts suggest a prioritization of cortisol production, essential for survival in critically ill patients, potentially at the expense of adrenal androgens.