title: Evaluation of activity of hypothalamo-pituitary-gonadal axis in postmenopausal women suffering from severe acute illness.
abstract: OBJECTIVE
  Postmenopausal women constitute an ideal model for studying the extent of hypothalamo-pituitary gonadal (HPG) axis suppression in critical illness as the gonadotropins are normally high and non-cyclical in them. The objective was to assess the impact of acute severe illness in postmenopausal women on the HPG axis and the activities of the hypothalamo-pituitary-adrenal (HPA), the hypothalamo- pituitary-thyroid (HPT) axes; and levels of serum prolactin, by comparison between critically ill postmenopausal women and otherwise healthy postmenopausal women.
  
  
  METHODS
  Thirty five consecutive postmenopausal women older than 60 yr admitted to medical intensive care with a s0 implified a0 cute p0 hysiology s0 core II (SAPS II) more than 30 were included. On day five of their in-hospital stay, blood samples were collected for oestradiol, luteinizing hormone (LH), follicle stimulating hormone (FSH), cortisol, androstenedione, prolactin and thyroid profile. Thirty five apparently healthy postmenopausal women were selected as controls.
  
  
  RESULTS
  Levels of LH, FSH, thyrotropin, free thyroxin (fT 4 ) and free tri-iodothyronine (fT 3 ) were lower while oestradiol, cortisol and dehydroepiandrosterone were higher among patients in comparison to healthy controls. Prolactin levels were similar in patients and controls. Among sick patients both FSH and fT 4 showed a negative correlation ( P<0.05) with the SAPS II score.
  
  
  CONCLUSIONS
  In critically ill postmenopausal women, paradoxically elevated oestrogen levels despite gonadotropin suppression suggests a non-ovarian origin. Prolactin remained unaltered in patients despite their illness, possibly reflecting atrophy of lactotrophs in menopause.
authors.forename: M Neelima
authors.initials: MN
authors.lastname: Raj
authors.affiliation: Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
authors.forename: V
authors.initials: V
authors.lastname: Suresh
authors.forename: Arun
authors.initials: A
authors.lastname: Mukka
authors.forename: Amaresh
authors.initials: A
authors.lastname: Reddy
authors.forename: Alok
authors.initials: A
authors.lastname: Sachan
authors.forename: Alladi
authors.initials: A
authors.lastname: Mohan
authors.forename: B
authors.initials: B
authors.lastname: Vengamma
authors.forename: P V L N Srinivas
authors.initials: PV
authors.lastname: Rao
mesh_terms: D000208:Acute Disease; D000368:Aged; D016638:Critical Illness; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D007362:Intensive Care Units; D007986:Luteinizing Hormone / Q000097:blood; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D017698:Postmenopause / Q000097:blood*; D011388:Prolactin / Q000097:blood; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood
chemical_list: D004958:Estradiol; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin; D013974:Thyroxine; D006854:Hydrocortisone