Testosterone levels in acute exacerbation of chronic obstructive pulmonary disease: relationship with severity indices
Antonio Mancini1, Riccardo Inchingolo2, Alessandro Di Marco Berardino2, Vincenzo Di Donna1, Erika Leone1, Giuseppe Maria Corbo2, Salvatore Valente2 & Alfredo Pontecorvi1
Chronic obstructive pulmonary disease (COPD) patients could have altered endocrine function as different endocrine organs (gonads, pituitary, thyroid and pancreas) can be affected depending on the phenotype of the disease and the degree of systemic inflammation. Anabolic hormones can be involved as COPD patients can show weight loss and muscle wasting and both these conditions can modify natural history of the disease. Moreover COPD patients can frequently have acute exacerbations (AECOPD) which are considered risk factors for a worse quality life and mortality. The aim of our study is to investigate the association between anabolic hormones, like insulin-like growth factor 1 (IGF1), testosterone and its metabolites with prognostic indices of AECOPD.
Twenty inpatients, aged 75±14 years, 15 males, hospitalised for acute exacerbation, were enrolled. The severity of clinical status was evaluated by acute physiology and chronic health evaluation (APACHE) II score. Hormones (IGF1, testosterone, diidrotestosterone, estradiol) were assayed by RIA. Steroid hormone binding globulin was also assayed to determinate free-testosterone (f-testosterone).
Mean IGF1 levels were normal (82±33 pg/ml), whereas both mean testosterone levels (1.6±1.7 ng/ml) and mean f-testosterone levels (0.02±0.01 ng/ml) were lower than normal values.
Patients with normal IGF1 values showed higher APACHE II then patients with low values (P=0.02). Patients with low testosterone values showed higher APACHE II then patients with normal values (P=0.03) and a linear inverse relationship was found between APACHE II and f-testosterone. Moreover in the multiple regression analysis adjusting for age and sex both testosterone and f-testosterone were directly associated to the ratio PaO2/FiO2 (P=0.02).
In conclusion, our data demonstrated that COPD patients with low levels of testosterone tended to have worse acute exacerbations with low values of PaO2.