Gonadal steroids in critical illness.
Gonadal steroids are metabolized in target cells and then interact with specific receptors to exert genomic and nongenomic effects. Complex feedback loops that involve the immune-neuroendocrine axis, limbic system, and gonadal steroids play a vital role in the adaptation to critical illness. Preclinical studies demonstrate adverse physiological effects of androgens on the cardiovascular and immune systems despite its purported anabolic effects. Similar models also demonstrate salutary effects of estrogens on these systems. Thus, during the catabolic phases of acute and chronic critical illness, estrogen, and not androgen, therapy may prove to be a valuable intervention. However, during the post-critical illness recovery phase, when anabolism is critical, androgen therapy may still be useful and safe.
Mechanick
Jeffrey I
JI
Division of Endocrinology, Diabetes and Bone Disease, Mount Sinai School of Medicine, 1192 Park Avenue, New York, NY 10128, USA. jmechanick@aol.com
Nierman
David M
DM
D000728:Androgens / Q000502:physiology / Q000627:therapeutic use; D000818:Animals; D016638:Critical Illness; D004967:Estrogens / Q000502:physiology / Q000627:therapeutic use; D005260:Female; D012739:Gonadal Steroid Hormones / Q000502:physiology / Q000627:therapeutic use*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D012737:Sex Factors; D013312:Stress, Physiological / Q000188:drug therapy* / Q000503:physiopathology*
D000728:Androgens; D004967:Estrogens; D012739:Gonadal Steroid Hormones