Androgens in Men During Illness, Exercise and Psychological Stress

Semple, Colin Gordon (1990) Androgens in Men During Illness, Exercise and Psychological Stress. MD thesis, University of Glasgow.

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My early clinical experience had demonstrated that abnormalities of endocrine testing particularly with regards to thyroid function are common in ill patients. Interest in endocrine effects of illness was further stimulated by my study of hormone levels of uraemic patients undergoing differing forms of dialysis therapy. Chronic renal failure resulted in abnormal hypothalamic-pituitary-testicular and hypothalamic-pituitary-thyroid function irrespective of the nature of dialysis. Evidence for low levels of adrenal androgen in serum of uraemic patients was also found. As it was well known that abnormalities of thyroid function occurred in a variety of illnesses so it appeared possible that abnormalities of adrenal androgen status and hypothalamic-pituitary-testicular function might also be non-specific consequences of illness. To investigate this hypothesis these endocrine parameters were measured in several groups of patients:- those ill in a general medical ward, in diabetic men with ketoacidosis, during recovery from burns injury and before and after surgery. Serum levels of the most abundant adrenal androgen dehydroepiandrosterone sulphate (DHAS) were low in patients with a variety of non-endocrine medical illnesses only if they had been unwell for more than two weeks while serum androstenedione concentrations were higher than in controls irrespective of the duration of illness. Testosterone levels were also low but this was not related to the duration or severity of illness nor could it be accounted for by changes in binding proteins, hyperprolactinaemia nor on the basis of classical primary or secondary testicular failure. A study of men during an episode of diabetic ketoacidosis revealed that this complication of diabetes mellitus is also accompanied by depression of serum testosterone concentrations. However serum testosterone concentrations of non-ketotic diabetic men at routine review were not found to be related to diabetic control as assessed by glycosylated haemoglobin estimation. There was some limited evidence in the literature to suggest that adrenal androgen levels in diabetic men might be low and that this might have a deleterious effect on islet cell function but no abnormality of these hormones could be demonstrated in this group of patients. 19 burned men were followed sequentially for several weeks. Profound depression of serum testosterone concentrations for several weeks was found with levels falling into the range found in healthy females in the majority of patients studied. This could not be explained on the basis of binding protein changes nor by alterations in the concentrations of prolactin or gonadotrophins. DHAS levels although normal within 24 hours of admission fell to subnormal levels and remained low for several weeks. Serum androstenedione levels were high following admission and tended to remain so for several weeks. These changes in adrenal androgen concentrations were reminiscent of my observations during medical illness. Serum gonadotrophin levels of post-menopausal females were studied following cholecystectomy. Unlike the situation in medically ill men this operation led to a marked reduction in gonadotrophin levels sometimes down to the pre-menopausal range. Serum DHAS levels fell to below control values four days after surgery while serum androstenedione concentrations rose transiently post-operatively. The situation was however complicated by the administration of several drugs in particular parenteral opioids which might have affected gonadotrophin levels. As such profound endocrine changes had been observed with illness, it was of interest to discover whether these were specific to illness or whether other forms of stress such as the physical stress associated with exercise or the psychological stress accompanying academic examinations might result in similar changes. Following marathon running there was a small fall in serum testosterone concentrations. The situation differed from that following illness in that there was a massive elevation of serum cortisol as well as a fall in luteinising hormone (LH) levels. On the other hand veteran athletes who had run at least 25 miles a week for many years and who are therefore exposed to recurring and chronic physical stress had normal serum testosterone levels. Neither veteran athletes nor marathon runners showed evidence of a reduction in serum concentrations of adrenal androgens. The stress of physical exercise has a short-lived adverse effect on testicular function but unlike illness there are no changes in adrenal androgen levels. Review of the literature suggested that psychological stress can adversely affect gonadal function. (Abstract shortened by ProQuest.).

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine, Kinesiology, Endocrinology
Date of Award: 1990
Depositing User: Enlighten Team
Unique ID: glathesis:1990-78123
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 28 Feb 2020 12:09
Last Modified: 28 Feb 2020 12:09

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