Hypogonadotropinemia in non-thyroidal, non-pituitary critically ill post-menopausal women
Lee, Y.J.; Tsai, J.H.; Shin, S.J.; Torng, J.K.; Lai, Y.H.; Guh, J.Y.; Chen, J.H.
Journal of the Formosan Medical Association 87(8): 765-772
1988
ISSN/ISBN: 0371-7682 PMID: 3241155 Document Number: 309369
Twenty-four critically ill post-menopausal women were studied to evaluate hypothalamic-pituitary function by combined testing with thyrotropin-releasing hormone (TRH) and luteinizing-hormone releasing hormone (LHRH). Six patients with low basal serum TSH (group I, mean TSH 0.33.+-.0.05 .mu.U/ml) had significantly lower serum basal luteinizing hormone (LH, 46.7 .+-. 13.6 mIU/ml) and follicle stimulating hormone (FSH, 40.5 .+-. 12.5 mIU/ml) concentrations as compared to those of the normal controls (group III, mean TSH 1.86.+-.0.23 .mu.U/ml, mean LH 119.7.+-.11.2 mIU/ml, mean FSH 113.0.+-.7.9 mIU/ml, n =10). Their mean TSH response to TRH stimulation, LH and FSH responses to LHRH were all significantly blunted and delayed when compared to those in the control subjects. The other 18 patients with normal basal serum TSH(group II, 2.10.+-.0.30 .mu.U/ml) showed low basal serum LH(55.9.+-.15.5 mIU/ml) and FSH(44.5 .+-.10.4 mIU/ml) concentrations. The TSH response to TRH in group II was not significantly different from that in group III, but the LH and FSH responses to LHRH were significantly suppressed and delayed as compared with those in group III. Thus, diminished serum TSH, LH and FSH accompanied with blunted and delayed TSH, LH and FSH responses to their respective hypothalamic releasing hormones in fact exist in critically ill patients. These abnormalities indicate that critical illness may cause hypothalamic-pituitary dysfunctions. Furthermore, our results also suggest the hypothalamic-pituitary gonadal axis is more frequently affected than the hypothalamic-pituitary thyroid axis in postmenopausal women with critical illness.