Circulating immunoreactive inhibin and testosterone levels in men with critical illness

SUMMARY objective We aimed to concurrently characterize serial changes in circulating immunoreactive inhibin (IrlNH) and testosterone (T) as reflections of Sertoli and Leydig cell responses to acute critical illness in man design Blood samples were drawn within 24 hours of admission to an intensive Care Unit and at weekly intervals thereafter for up to 4 weeks while the patient remained in intensive Care Unit or after discharge to a general ward patients We studied 13 male subjects with critical illness requiring intensive therapy measurements Plasma levels of IrlNH, T, LH, FSH and sex hormone binding globulin (SHBG) were analysed in relation to (i) the severity of Illness as indicated by a sepsis score, acute physiology and chronic health evaluation score, and reverse triiodothyronine (rT3) levels and (ii) the outcome of illness as determined by discharge from intensive Care Unit and the two‐month mortality results Overall IrlNH levels remained normal and correlated negatively with rT3 ( r =–0·63, P = 0·001) but not with sepsis, acute physiology and chronic health evaluation score, or gonadotrophin levels. Neither admission nor serial IrlNH levels significantly distinguished between the different clinical outcomes. In contrast, T levels were depressed and inversely correlated with both sepsis and acute physiology and chronic health evaluation scores ( P > 0·02), and positively with gonadotrophips ( P > 0·01), but not rT3 levels. Men eventually discharged from the intensive Care Unit showed a rise, while those remaining showed a fall, in T levels ( P = 0·02, time–course interaction). Similarly, T levels were lower in patients who died than in survivors, despite the comparable T levels on admission ( P = 0·02, time–course interaction). Despite the fall in T levels, gonadotrophin levels remained inappropriately in the eugonadal range but higher in men who were discharged from intensive Care Unit ( P = 0·02, time–course interaction). FSH but not LH levels were correlated with sepsis score ( P = 0·402) but not acute physiology and chronic health evaluation score or rT3. conclusions Sertoli cell function as judged by circulating IrlNH levels is much less affected by acute critical Illness than is Leydig cell function as judged by circulating T levels. The suppressive effect of acute critical Illness on Leydig cell function is consistent with a hypothalamicpitultary lesion