Woolf P D, Hamill R W, McDonald J V, Lee L A, Kelly M
J Clin Endocrinol Metab. 1985 Mar;60(3):444-50. doi: 10.1210/jcem-60-3-444.
The effects of acute severe illness on pituitary-gonadal function were determined in 35 men and 19 women, including 12 who were postmenopausal. Seventeen men and 5 women had traumatic brain injury which resulted in coma. Twelve postmenopausal and 2 premenopausal women had intracranial vascular accidents. Eleven men had myocardial infarctions, while 7 men underwent elective surgery. Serial plasma samples were examined for testosterone (men), percentage of ultrafiltrable testosterone (men), estradiol (women), sex hormone-binding globulin, LH, and FSH. In men, mean testosterone levels fell by 271 +/- 72 (+/- SE), 202 +/- 63 and 195 +/- 75 ng/dl within 24 h of brain injury, myocardial infarction, or elective surgery, representing decreases of 55%, 43%, and 58%. Further declines occurred in the first and third groups to mean nadirs of 93 +/- 16 and 117 +/- 5 ng/dl, respectively. During recovery of neurological function there was no correlation between the testosterone level and the degree of neurological impairment; testosterone levels eventually returned to normal (627 +/- 77 ng/ml). The percentage of ultrafiltrable testosterone and sex hormone-binding globulin did not change in any group. Although significant decreases in mean immunoreactive LH and FSH levels were found after head trauma, and decreases in FSH were found in the men after surgery, these changes occurred after the decline in testosterone. Despite the fall in basal gonadotropin levels in the head trauma group, there were no significant differences in the gonadotropin responses to GnRH (100 micrograms) in 4 patients during their acute illness or recovery. LH, FSH, and estradiol levels in the premenopausal women were significantly lower on the second day of brain injury (LH, 10.3 +/- 4.7 vs. 3.5 +/- 0.6 mIU/ml; FSH, 3.8 +/- 1.9 vs. 1.4 +/- 0.8 mIU/ml, estradiol, 200 +/- 41 vs. 102 +/- 16 pg/ml) and remained suppressed for 7 days. Gonadotropin levels also fell in the postmenopausal women within 24 h; reductions in LH of 74% and in FSH of 62% were present by day 7 of study. We conclude that both men and women who are critically ill uniformly develop temporary hypogonadotropic gonadal insufficiency regardless of their illness. In men, it is manifested by low testosterone levels, while a comparable decrease in estradiol is present in women. The low testosterone concentrations are not due to reduced sex hormone-binding capacity. Based upon our data in postmenopausal women, hypogonadotropism also occurs in the presence of nonfunctioning gonads. Although our studies do not completely establish the pathophysiology of this disorder, they suggest a suprapituitary origin.
对35名男性和19名女性（包括12名绝经后女性）进行了急性重症疾病对垂体 - 性腺功能影响的研究。17名男性和5名女性患有创伤性脑损伤并导致昏迷。12名绝经后女性和2名绝经前女性发生了颅内血管意外。11名男性患有心肌梗死，7名男性接受了择期手术。对系列血浆样本检测了睾酮（男性）、可超滤睾酮百分比（男性）、雌二醇（女性）、性激素结合球蛋白、促黄体生成素（LH）和促卵泡生成素（FSH）。在男性中，脑损伤、心肌梗死或择期手术后24小时内，平均睾酮水平分别下降271±72（±标准误）、202±63和195±75 ng/dl，降幅分别为55%、43%和58%。第一组和第三组进一步下降，平均最低点分别为93±16和117±5 ng/dl。在神经功能恢复期间，睾酮水平与神经功能损害程度之间无相关性；睾酮水平最终恢复正常（627±77 ng/ml）。任何组中可超滤睾酮百分比和性激素结合球蛋白均未改变。尽管头部外伤后发现平均免疫反应性LH和FSH水平显著下降，手术后男性FSH水平下降，但这些变化发生在睾酮下降之后。尽管头部外伤组基础促性腺激素水平下降，但4例患者在急性疾病或恢复期间对促性腺激素释放激素（GnRH，100微克）的反应无显著差异。绝经前女性脑损伤第二天LH、FSH和雌二醇水平显著降低（LH，10.3±4.7对3.5±0.6 mIU/ml；FSH，3.8±1.9对1.4±0.8 mIU/ml，雌二醇，200±41对102±16 pg/ml），并持续抑制7天。绝经后女性促性腺激素水平在24小时内也下降；到研究第7天，LH下降74%，FSH下降62%。我们得出结论，无论患有何种疾病，重症男女均会一致出现暂时性低促性腺激素性性腺功能不全。在男性中，表现为睾酮水平降低，而女性中雌二醇有类似程度的下降。低睾酮浓度并非由于性激素结合能力降低所致。根据我们对绝经后女性的数据，在性腺无功能的情况下也会发生低促性腺激素血症。尽管我们的研究并未完全阐明这种疾病的病理生理学，但提示其起源于垂体以上部位。
