Hypothalamic-pituitary dysfunction in respiratory hypoxia.

Abstract

Eight hypoxic male patients with stable chronic obstructive airways disease were submitted for combined anterior pituitary function testing. All subjects showed normal growth hormone and essentially normal cortisol responses to adequate hypoglycaemia, two subjects showed delayed responses of thyroid stimulating hormone to administered thyrotrophin releasing hormone and all had basal prolactin levels within normal limits. Basal levels of luteinising hormone were significantly lower than in the group of age-matched controls (p < 002) but there was a normal increment after the injection of gonadotrophin releasing hormone. Basal levels of follicle stimulating hormone were significantly lower than in the controls (p < 001), and there was also a reduced response from the pituitary after injection of gonadotrophin releasing hormone (p < 0-01). Resting levels of the thyroid hormones thyroxine and tri-iodothyronine were normal while the expected subnormal testosterone level was observed (p < 0 05). These results show that hypoxia can produce abnormalities of hypothalamic-pituitary function and that these are primarily located in the hypothalamicpituitary-testicular axis.While studying metabolic aspects of chronic obstructive airways disease (COAD), we have recently found reduced serum testosterone values in affected men,' and have been able to demonstrate an association between severity of hypoxia and degree of testosterone suppression.2 Theoretical consequences of endocrine abnormalities have been discussed in these communications with particular reference to the difference in body habitus between overweight chronic bronchitic "blue bloaters" and thin emphysematous "pink puffers." Though such hormonal changes had not previously been described in patients with COAD, reduced urinary 17-ketosteroid production had already been noted at high altitude3 and in emphysema.4 We have postulated that hypoxia produces low androgen output by suppressing hypothalamic-pituitary function. However, decreased response of testosterone secretion after testicular stimulation by injection of human chorionic gonadotrophin (HCG)

Pituitary-Gonadal Dysfunction in Male Patients with Lung Cancer: Association with serum inhibin levels

“…Previous studies of the primary defect in disease-induced gonadal endocrine failure have yieided inconsistent results with respect to the mechanisms re3consible (9,(26)(27)(28)(29)(30). Our findings of low free testosterolic levels and concurrently elevated gonadotrophins in debilitated lung cancer patients are suggestive of a primary gonadal dysfunction.…”

“…Hypothalamic-pituitary-gonadal axis failure may be a result of various pathological states in several organ systems. In numerous studies, male patients with lung cancer (2-7), patients undergoing cyclic chemotherapy for lung cancer ( I , 2), and patients with chronic hypoxic disease (2,(8)(9)(10)(11)(12)) have all been shown to display these features. Although the 'fatigue syndrome' may be responsible for the gonadal endocrine dysfunction in these patients (13, 14), the mechanisms responsible for this phenomenon have not been resolved.…”

The effect of toxoplasmosis on the level of some sex hormones in males blood donors in Baghdad

“…Spartt et al (1992) suggested that primary hypogonadism occurs in acute illness. Second hypogonadism in mean with critical illness, surgery (Wang et al 1978) or respiratory failure (Semple et al 1981) is attributed to hypogonadotropism. Reproductive axis suppression in acute illness is related to disease severity (Dong et al 1992).…”

Hypoxia Inducible Factor Expression and Angiogenesis – Analysis in the Pituitary Gland and Patterns of Death

“…In 1981, Semple et al, reported that hypoxia induced during chronic obstructive airway diseases in humans can lead to alterations of the hypothalamic-pituitary function, particularly in the pituitary-testicular axis (18), although these findings were subsequently questioned in a study by Banks et al (19). Studies in rats and pikas and ewes, exposed to altitude mediate reduced oxygen breathing suggested that hypoxic stress increases release of ACTH via cAMP (4,20).…”