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Changes in the Plasma Sex Hormone Profile in Males with Severe Concomitant Injury

https://doi.org/10.15360/1813-9779-2009-3-5

Abstract

Objective: to perform a complex study of typical plasma sex hormone changes and their functional significance in males with severe concomitant injury (SCI). Subjects and methods. Fifty-nine males aged 18—49 years who had SCI were enrolled in the study. The admission severity was an APACHE II score of 18.6±2.4. According to the outcome of the disease, all the patients were divided into 2 groups: A) survivors; B) deceased persons. A control comprised 12 healthy male donors aged 19-36 years, in whom the levels of 8 sex steroids were measured. The standard procedures were used to comparatively analyze the concentrations of pituitary reproductive hormones and aldosterone. Hormonal concentrations were studied over time on posttraumatic days 1, 3, 5, 7, 10, and 15. The plasma hormone profile was examined by test kits (BSL, USA) on a Stat Fax 2100 device (Awareness Technology Inc., USA) for enzyme immunoassay. Prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), progesterone (P), 17-hydroxyprogesterone (17-OH-P), dehydroepiandrosterone sulfate (DHEA-S), androstendione (A), testosterone (T), dihydrotestosterone (DHT), estrone (E1), estradiol (E2), and aldosterone were determined. Results. The complex study of phasic changes in the profile of 11 plasma sex hormones was first conducted in males in the posttraumatic period. Moreover, the typical plasma hormonal changes were elevated prolactin levels and their phasic variations, normal LH and FSH levels with a tendency for further phasic LH changes and FSH reduction. After the injury, the plasma concentration of P was increased and that of 17-OH-P was decreased. The levels of A and DHEA-S varied in the normal range with a tendency for DHEA-S to be lower during the process. In the posttraumatic period, the plasma content of T and DHT was substantially reduced and that of E1 and E2 was increased. The deceased patients generally showed higher levels of A, DHEA-S, and estrogens as a reflection of dysregulatory pathology and complications. The changes revealed in hormonal levels are of significance in understanding the pathogenesis of SCT and its sequels. This may serve as a basis for the development of new therapy methods using sex hormones as adaptogens in the postresuscitative period. Key words: severe concomitant injury, sex hormones, prolactin, luteinizing hormone, follicle-stimulating hormone, progesterone, 17-hydroxyprogesterone, androgens, estrogens.

References

1. Волков А. В.

2. Волков А. В, Аврущенко М. Ш., Горенкова Н. А., Заржецкий Ю. В.Значение полового диморфизма и репродуктивных гормонов в патогенезе и исходе постреанимационной болезни. Общая реаниматология 2006; II (5—6): 70—78.

3. Волков А. В., Мишарина Г. В., Алексеева Г. В.Особенности гормонального статуса при длительной коме у мужчин. Анестезиология и реаниматология 2001; 6: 56—58.

4. Волков А. В, Мишарина Г. В., Алексеева Г. В., Муравьев О. Б.Эндокринные синдромы при критических состояниях. Вестник РАМН 1997; 10: 13—17.

5. Dong Q, Hawker F., McWilliam D. et al.Circulating immunoreactive inhibin and testosterone levels in men with critical illness. Clin. Endocrinol. (Oxf). 1992; 36 (4): 399—404.

6. Remmers D. E, Cioffi W .G., Bland K. I. et al.Testosterone: the crucial hormone responsible for depressing myocardial function in males after trauma-hemorrhage. Ann. Surg. 1998; 227 (6): 790—799.

7. Clark J. D, Raggatt P. R., Edwards O. M.Hypothalamic hypogonadism following major head injury. Clin.Endocrinol (Oxf). 1988; 29 (2): 153—165.

8. May A. K., Dossett L. A., Norris P. R. et al.Estradiol is associated with mortality in critically ill trauma and surgical patients. Crit. Care Med. 2008; 36 (1): 62—6

9. Stein D. G.Brain damage, sex hormones and recovery: a new role for progesterone and estrogen? Trends Neurosci. 2001; 24 (7): 386—391.

10. Spratt D. I.Altered gonadal steroidogenesis in critical illness: is treatment with anabolic steroids indicated? Best Pract. Res. Clin. Endocrinol. Metab. 2001; 15 (4): 479—494.

11. Mendelsohn M. E., Karas R. H.The protective effects of estrogen on the cardiovascular system. N. Engl. J. Med. 1999; 340 (23): 1801 — 18

12. Beishuizen A., Thijs L. G., Vermes I.Decreased levels of dehy-droepiandrosterone sulphate in severe critical illness: a sign of exhausted adrenal reserve? Crit. Care 2002; 6 (5): 434—438.

13. Zellweger R., Wichmann M. W., Ayala A. et al.Prolactin: a novel and safe immunomodulating hormone for the treatment of immunodepression following severe hemorrhage. J. Surg. Res. 1996; 63 (1): 53—58.

14. Волков А. В., Мороз В. В., Ежова К. Н., Заржецкий Ю. В.Роль половых стероидов в восстановительном периоде после клинической смерти. Общая реаниматология 2008; IV (1): 18—20.

15. Kuebler J. F., Jarrar D., Toth B. et al.Estradiol administration improves splanchnic perfusion following trauma-hemorrhage and sepsis. Arch. Surg. 2002; 137 (1): 74—79.

16. Noppens R. R., Kofler J., Hurn P. D., Traystman R. J.Dose-dependent neuroprotection by 17beta-estradiol after cardiac arrest and cardiopul-monary resuscitation. Crit. Care Med. 2005; 33 (7): 1595—1612.

17. Kuebler J. F., Jarrar D., Bland K. I. et al.Progesterone administration after trauma and hemorrhagic shock improves cardiovascular responses. Crit. Care Med. 2003; 31 (6): 1786—1793.

18. Remmers D. E., Wang P., Cioffi W. G. et al.Testosterone receptor blockade after trauma-hemorrhage improves cardiac and hepatic functions in males. Am. J. Physiol. 1997; 273 (6 Pt 2): H2919—H2925.

19. Wichmann M. W., Zellweger R., DeMaso C. M. et al.Mechanism of immunosuppression in males following trauma-hemorrhage. Critical role of testosterone. Arch. Surg. 1996; 131(11): 1186—1191.

20. МорозВ. В.(ред.) Фундаментальные проблемы реаниматологии: Тр. ин-та. 3. Шок. Введение в проблему. М.; 2003.

21. Йен С. С. К.Репродуктивная эндокринология. Йен С. С. К., Джаф-фе Р. Б. (ред.) Пер. с англ. М.: Медицина; 1998. т. 1. 120—149.

22. Zellweger R., Wichmann M. W., Ayala A. et al.Prolactin: a novel and safe immunomodulating hormone for the treatment of immunodepression following severe hemorrhage. J. Surg. Res. 1996; 63 (1): 53—58.

23. Kuebler J. F., Yokoyama Y., Jarrar D. et al.Administration of progesterone after trauma and hemorrhagic shock prevents hepatocellular injury. Arch. Surg. 2003; 138 (7): 727—734.

24. Spratt D. I., Morton J. R., Kramer R. S. et al.Increases in serum estrogen levels during major illness are caused by increased peripheral aromati-zation. Am. J. Physiol. Endocrinol. Metab. 2006; 291 (3): 631—638.

25. Hurn P. D., Macrae I. M.Estrogen as a neuroprotectant in stroke. J. Cereb. Blood Flow Metab. 2000; 20 (4): 631—652.

26. McCullough L. D., Alkayed N. J., Traystman R. J. et al.Postischemic estrogen reduces hypoperfusion and secondary ischemia after experimental stroke. Stroke 2001; 32 (3): 796—802.

27. Yang S., Zheng R., Hu S.Mechanism of cardiac depression after trauma-hemorrhage: increased cardiomyocyte IL-6 and effect of sex steroids on IL-6 regulation and cardiac function. Am. J. Physiol. Heart Circ. Physiol. 2004; 287 (5): 2183—2191.


Review

For citations:


Yezhova K.N., Volkov A.V., Ostapchenko D.A., Moroz V.V. Changes in the Plasma Sex Hormone Profile in Males with Severe Concomitant Injury . General Reanimatology. 2009;5(3):5. (In Russ.) https://doi.org/10.15360/1813-9779-2009-3-5

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ISSN 1813-9779 (Print)
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