A study of serum testosterone as a prognostic indicator in patients with respiratory failure on mechanical ventilation
Keywords:
endocrine, critical illness, testosterone, respiratory failure, mechanical ventilationAbstract
Patients on mechanical ventilation tend to have a multitude of biochemical changes, many due to adrenal suppression or functional adrenal insufficiency Abnormal levels of gonadal steroids poses significant physiologic effects in critically ill patients. Hypotestosteronemia, defined as a serum total testosterone level <250 ng/dL (<8.7 nmol/L) or free testosterone level <0.75 ng/dL (<0.03 nmol/L), is a common finding among male patients with critical illness. In this this study we determine if serum testosterone can be used as a prognostic indicator in patients with respiratory failure, on mechanical ventilation. This is a prospective observational study done over a period of 18 months at a tertiary care canter in Mysore. Study participants included male patients admitted to ICU of JSS Hospital with documented acute respiratory failure on arterial blood gas analysis (ABG), who were mechanically ventilated for more than 24 hours. Blood sample was collected at 24 hours and 72 hours post intubation and serum testosterone levels were estimated using Electro Chemiluminescence assay. Our results indicate 90.5% of the patients had low testosterone levels at 24 hours, whereas 97.1% of the patients had hypotestosteronemia at 72 hours post intubation.
Downloads
References
Mechanick JI, Brett EM. Nutrition and the chronically critically ill patient. Current Opinion in Clinical Nutrition and Metabolic Care. 2005; 8:33-39.
Mechanick J, Nierman D. Gonadal Steroids in Critical Illness. Critical Care Clinics. 2006;22(1):87-103.
Kelly M, Qiu J et al. Estrogen Modulation of G-Protein-Coupled Receptor Activation of Potassium Channels in the Central Nervous System. Annals of the New York Academy of Sciences. 2003;1007(1):6-9.
Spratt D, Cox P et al. Reproductive axis suppression in acute illness is related to disease severity. The Journal of Clinical Endocrinology & Metabolism. 1993;76(6):1548-1554.
Morris J, Mackenzie E et al. Mortality in Trauma Patients. The Journal of Trauma: Injury, Infection, and Critical Care. 1990;30(12):1476-1482.
Dong Q, Hawker F et al. Circulating immunoreactive inhibin and testosterone levels in men with critical illness. Clinical Endocrinology. 1992;36(4):399-404.
Luppa P, Munker R et al. Serum androgens in intensive-care patients: correlations with clinical findings. Clinical Endocrinology. 1991;34(4):305-310.
Breen K, Stackpole C et al. Does the Type II Glucocorticoid Receptor Mediate Cortisol-Induced Suppression in Pituitary Responsiveness to Gonadotropin-Releasing Hormone?. Endocrinology. 2004;145(6):2739-2746.
Shores M, Matsumoto A et al. Low Serum Testosterone and Mortality in Male Veterans. Archives of Internal Medicine. 2006;166(15):1660.
Christeff N, Benassayag C et al. Elevated oestrogen and reduced testosterone levels in the serum of male septic shock patients. Journal of Steroid Biochemistry. 1988;29(4):435-440.
Nierman D, Mechanick J. Hypotestosteronemia in chronically critically ill men. Critical Care Medicine. 1999;27(11):2418-2421.
Arlt W, Callies F et al. Dehydroepiandrosterone Replacement in Women with Adrenal Insufficiency. New England Journal of Medicine. 1999;341(14):1013-1020.
Ebeling P, Koivisto VA: Physiological importance of dehydroepiandrosterone. Lancet 1994, 343:1479-1481.
Oberbeck R, Dahlweid M et al. Dehydroepiandrosterone decreases mortality and improves cellular immune function during polymicrobial sepsis. Critical Care Medicine 2001, 29:380-384.
Almoosa K, Gupta A et al. Low Testosterone Levels are Frequent in Patients with Acute Respiratory Failure and are Associated with Poor Outcomes. Endocrine Practice. 2014;20(10):1057–63.
Semple PD, Beastall GH et al. Serum testosterone depression associated with hypoxia in respiratory failure. Clinical Sciences (London). 1980; 58:105-106.
Nierman D, Mechanick J. Hypotestosteronemia in chronically critically ill men. Critical Care Medicine. 1999;27(11):2418-2421.
Beishuizen A, Thijis LG et al. Decreased levels of dehydroepiandrosteronesulphate in severe critical illness: a sign of exhausted adrenal reserve. Critical Care. 2002;6(5):434–8.
Kimura H, Tatsumi K et al. Progesterone Therapy for Sleep Apnea Syndrome Evaluated by Occlusion Pressure Responses to Exogenous Loading. American Review of Respiratory Disease. 1989;139(5):1198-1206.
Van den Berghe G. Endocrine evaluation of patients with critical illness. Endocrinol Metab Clin North Am. 2003;32(2):385-410.
Beishuizen A, Vermes I, Hylkema BS, Haanen C: Relative eosinophilia and functional adrenal insufficiency in critically ill patients. Lancet 1999, 353(9175):1675-6.
Ilias I, Stamoulis K, Armaganidis A, Lyberopoulos P, Tzanela M, Orfanos S et al. Contribution of endocrine parameters in predicting outcome of multiple trauma patients in an intensive care unit. Hormones 2007: 218-226.
A Bech, H Van Leeuwen et al. Etiology of low testosterone levels in male patients with severe sepsis requiring mechanical ventilation. Critical Care 2013; 17(Suppl 2):448.
Daniel M Kelly, T Hugh Jones. Testosterone: a metabolic hormone in health and disease. Journal of Endocrinology Jun 2013; 3:25-45
Jones TH 2010.Testosterone deficiency: a risk factor for cardiovascular disease? Trends in Endocrinology and Metabolism21496–503. DOI: 10.1016/j.tem.2010.03.002.
Wang C, Chan V et al. Effect of surgical stress on pituitary-testicular function. Clinical Endocrinology (Oxford). 1978; 9:255-266.
Wang C, Chan V et al. Effect of acute myocardial infarction on pituitary-testicular function. Clinical Endocrinology (Oxford). 1978; 9:249-253.
Vogel AV, Peake GT et al. Pituitary-testicular axis dysfunction in burned men. Journal of Clinical Endocrinology and Metabolism. 1985; 60:658-665.
Woolf PD, Hamill RW et al. Transient hypogonadotropic hypogonadism caused by critical illness. Journal of Clinical Endocrinology and Metabolism. 1985; 60:444-450.
Wolfe R, Ferrando A et al. Testosterone and muscle protein metabolism. Mayo Clinic Proceedings. 2000;75: S55-S59.
Pastor-Pérez FJ Manzano-Fernández Set al. Anabolic status and functional impairment in men with mild chronic heart failure. American Journal of Cardiology. 2011; 108:862-866.
Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2010; 95:2536-2559.
Demling RH, Orgill DP. The anticatabolic and wound healing effects of the testosterone analog oxandrolone after severe burn injury. Journal of Critical Care. 2000; 15:12-17.
Wolf SE, Edelman LS et al. Effects of oxandrolone on outcome measures in the severely burned: a multicenter prospective randomized double-blind trial. Journal of Burn Care and Research. 2006; 27:131-139.
Hart DW, Wolf SE, Ramzy PI, et al. Anabolic effects of oxandrolone after severe burn. Annals of Surgery. 2001; 233:556-564.
Toma M, McAlister FA, Coglianese EE et al. Testosterone supplementation in heart failure: a meta-analysis. Circulation: Heart Failure. 2012; 5:315-321.
Ullah MI, Washington T et al. Testosterone deficiency as a risk factor for cardiovascular disease. Hormone and Metabolic Research. 2011; 43:153-164.
Bulger EM, Jurkovich GJ et al. Oxandrolone does not improve outcome of ventilator dependent surgical patients. Annals of Surgery. 2004; 240:472-478; discussion 478-480.
Vigen R, O’Donnell CI, Barón AE et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. Journal of American Medical Association. 2013; 310:1829-1836.
Finkle WD, Greenland S, Ridgeway GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. Public Library of Science: One. 2014;9:e85805.
Pitteloud N, Mootha VK et al. Relationship between testosterone levels, insulin sensitivity and mitochondrial function in men. Diabetes Care, American Diabetes Association; 2005.
Srikanthan P, Karlamangla AS. 2011. Relative muscle mass is inversely associated with insulin resistance and prediabetes. Findings from the Third National Health and Nutrition Examination Survey. Journal of Clinical Endocrinology and Metabolism. 962898–2903.
Atlantis E, Fahey P, et al. Endogenous testosterone level and testosterone supplementation therapy in chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis. BMJ Open. 2013;3(8).
O’Shea SD, Taylor NF, Paratz JD. Progressive resistance exercise improves muscle strength and may improve elements of performance of daily activities for people with COPD: a systematic review. Chest 2009; 136:1269–83.
COPD Working Group. Pulmonary rehabilitation for patients with chronic pulmonary disease (COPD): an evidence-based analysis [Internet]. Ontario health technology assessment series. Health Quality Ontario; 2012 [cited 2019Oct20].
Guo W, Wong S, Li M, Liang W, Liesa M, Serra C, et al. Testosterone Plus Low-Intensity Physical Training in Late Life Improves Functional Performance, Skeletal Muscle Mitochondrial Biogenesis, and Mitochondrial Quality Control in Male Mice. PLoS ONE. 2012Nov;7(12).
Daniel M Kelly, T Hugh Jones. Testosterone: a metabolic hormone in health and disease. Journal of Endocrinology (2013)217, R25-R45.
Ioannis Ilias, Konstantinos Stamoulis et al. Contribution of endocrine parameters in predicting outcome of multiple trauma patients in an intensive care unit. Hormones 2007, 6(3):218-226.
Amany Shaker, Ashraf El-Shora et al. Endocrinal disturbances and systemic inflammation in chronic obstructive pulmonary disease (COPD). Egyptian Journal of Chest Diseases and Tuberculosis (2012) 61, 81–88.
Akbaş T, Karakurt S, et al. The Endocrinologic Changes in Critically Ill Chronic Obstructive Pulmonary Disease Patients. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2010;7(4):240–7.
Albertus Beishuizen, Lambertus G Thijs et al. Decreased levels of dehydroepiandrosterone sulphate in severe critical illness: a sign of exhausted adrenal reserve. Critical Care. October 2002. Vol 6 No 5.
Haggstorm M, Richfield D (2014). Diagram of the pathways of human steroidogenesis. WikiJournal of Medicine. Doi:10.15347/wjm/2014.005.
G. Gayan-Ramirez, M. Decramer. Effects of mechanical ventilation on diaphragm function and biology. European Respiratory Journal 2002; 20: 1579–1586.
Wu J-Y, Hsu S-C et al. Adrenal insufficiency in prolonged critical illness.
Critical care 2008;12(3): R65 doi: 10.1186/cc6895. Epub 2008 May 8.
Häggström M, Richfield D (2014). "Diagram of the pathways of human steroidogenesis". Wiki Journal of Medicine. doi:10.15347/wjm/2014.005.
Published
How to Cite
Issue
Section
Copyright (c) 2022 International journal of health sciences

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.








