Evaluation of activity of hypothalamo-pituitary-gonadal axis in postmenopausal women suffering from severe acute illness

Abstract

Background & objectives:Postmenopausal women constitute an ideal model for studying the extent of hypothalamo-pituitary gonadal (HPG) axis suppression in critical illness as the gonadotropins are normally high and non-cyclical in them. The objective was to assess the impact of acute severe illness in postmenopausal women on the HPG axis and the activities of the hypothalamo-pituitary-adrenal (HPA), the hypothalamo- pituitary-thyroid (HPT) axes; and levels of serum prolactin, by comparison between critically ill postmenopausal women and otherwise healthy postmenopausal women.Methods:Thirty five consecutive postmenopausal women older than 60 yr admitted to medical intensive care with a Simplified Acute Physiology Score II (SAPS II) more than 30 were included. On day five of their in-hospital stay, blood samples were collected for oestradiol, luteinizing hormone (LH), follicle stimulating hormone (FSH), cortisol, androstenedione, prolactin and thyroid profile. Thirty five apparently healthy postmenopausal women were selected as controls.Results:Levels of LH, FSH, thyrotropin, free thyroxin (fT4) and free tri-iodothyronine (fT3) were lower while oestradiol, cortisol and dehydroepiandrosterone were higher among patients in comparison to healthy controls. Prolactin levels were similar in patients and controls. Among sick patients both FSH and fT4 showed a negative correlation (P<0.05) with the SAPS II score.Interpretation & conclusions:In critically ill postmenopausal women, paradoxically elevated oestrogen levels despite gonadotropin suppression suggests a non-ovarian origin. Prolactin remained unaltered in patients despite their illness, possibly reflecting atrophy of lactotrophs in menopause.

Impact of severity of illness on the function of the hypothalamo-pituitary-gonadal axis in postmenopausal women with acute severe illness: Implications for predicting disease outcome

“…Details of the study population and methodology have been reported elsewhere. [ 10 ] Briefly, 35 postmenopausal women (>60 years of age) admitted to the intensive care units (of Departments of Medicine and Neurology) with a variety of acute severe medical illnesses and having a Simplified Acute Physiology Score II (SAPS II)[ 11 ] >30 (consistent with an in-hospital mortality rate ≥10%) were recruited for the study. Predicted death rates for in-hospital mortality were calculated from the SAPS II based on the published formula.…”

“…Sample size for the original study[ 10 ] was calculated for an expected 25% or greater reduction in mean gonadotropin levels in sick postmenopausal women when compared to healthy postmenopausal controls for a power of ≥80% and a significance level ( P < 0.05). The obtained minimum sample size was 27 for detecting change in LH and 29 for change in FSH.…”

“…Comparison of gonadotropins and estradiol levels between sick patients and healthy controls recruited into this study has been reported earlier. [ 10 ] Briefly, gonadotropin (both LH and FSH) levels were lower in patients than in controls. Paradoxically, estradiol levels were significantly elevated in the sick postmenopausal women than in the controls.…”

“…Paradoxically, estradiol levels were significantly elevated in the sick postmenopausal women than in the controls. [ 10 ]…”

Chronic Oral Administration of Tenebrio molitor Extract Exhibits Inhibitory Effect on Glucocorticoid Receptor Overexpression in the Hippocampus of Ovariectomy‐Induced Estrogen Deficient Mice

“…Hippocampal dentate gyrus is a region that is very sensitive to changes in the brain caused by estrogen. It is useful for studying the mechanisms of neurogenesis caused by a variety of factors involved in hypothalamic-pituitary-adrenal (HPA) axis adjustment (Agca, Batailler, Tillet, Chemineau, & Duittoz, 2008;Burgess & Handa, 1993;Li et al, 2011;Raj et al, 2016;Sheng et al, 2003;Zhang et al, 2016;Zhao et al, 2015). In other words, the glucocorticoid receptor (GR) is known as a main marker describing the regulatory mechanism of HPA axis and will be used a basis for determining the change in HPA axis regulation by estrogen deficiency in the present study.…”