{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T09:42:00Z","timestamp":1773308520726,"version":"3.50.1"},"reference-count":76,"publisher":"The Endocrine Society","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2001,7,1]]},"abstract":"<jats:p>Central hyposomatotropism and hypothyroidism have been inferred in long-stay intensive care patients. Pronounced hypoandrogenism presumably also contributes to the catabolic state of critical illness. Accordingly, the present study appraises the mechanism(s) of failure of the gonadotropic axis in prolonged critically ill men by assessing the effects of pulsatile GnRH treatment in this unique clinical context.<\/jats:p><jats:p>To this end, 15 critically ill men (mean \u00b1 sd age, 67 \u00b1 12 yr; intensive care unit stay, 25 \u00b1 9 days) participated, with baseline values compared with those of 50 age- and BMI-matched healthy men. Subjects were randomly allocated to 5 days of placebo or pulsatile iv GnRH administration (0.1 \u03bcg\/kg every 90 min). LH, GH, and TSH secretion was quantified by deconvolution analysis of serum hormone concentration-time series obtained by sampling every 20 min from 2100\u20130600 h at baseline and on nights 1 and 5 of treatment. Serum concentrations of gonadal and adrenal steroids, T4, T3, insulin-like growth factor I (IGF), and IGF-binding proteins as well as circulating levels of cytokines and selected metabolic markers were measured.<\/jats:p><jats:p>During prolonged critical illness, pulsatile LH secretion and mean LH concentrations (1.8 \u00b1 2.2 vs. 6.0 \u00b1 2.2 IU\/L) were low in the face of extremely low circulating total testosterone (0.27 \u00b1 0.18 vs. 12.7 \u00b1 4.07 nmol\/L; P &amp;lt; 0.0001) and relatively low estradiol (E2; 58.3 \u00b1 51.9 vs. 85.7 \u00b1 18.6 pmol\/L; P = 0.009) and sex hormone-binding globulin (39.1 \u00b1 11.7 vs. 48.6 \u00b1 27.8 nmol\/L; P = 0.01). The molar ratio of E2\/T was elevated 37-fold in ill men (P &amp;lt; 0.0001) and correlated negatively with the mean serum LH concentrations (r =\u2212 0.82; P = 0.0002). Pulsatile GH and TSH secretion were suppressed (P \u2264 0.0004), as were mean serum IGF-I, IGF-binding protein-3, and acid-labile subunit concentrations; thyroid hormone levels; and dehydroepiandrosterone sulfate. Morning cortisol was within the normal range. Serum interleukin-1\u03b2 concentrations were normal, whereas interleukin-6 and tumor necrosis factor-\u03b1 were elevated. Serum tumor necrosis factor-\u03b1 was positively correlated with the molar E2\/testosterone ratio and with type 1 procollagen; the latter was elevated, whereas osteocalcin was decreased. Ureagenesis and breakdown of bone were increased. C-Reactive protein and white blood cell counts were elevated; serum lactate levels were normal.<\/jats:p><jats:p>Intermittent iv GnRH administration increased pulsatile LH secretion compared with placebo by an increment of +8.1 \u00b1 8.1 IU\/L at 24 h (P = 0.001). This increase was only partially maintained after 5 days of treatment. GnRH pulses transiently increased serum testosterone by +174% on day 2 (P = 0.05), whereas all other endocrine parameters remained unaltered. GnRH tended to increase type 1 procollagen (P = 0.06), but did not change serum osteocalcin levels or bone breakdown. Ureagenesis was suppressed (P &amp;lt; 0.0001), and white blood cell count (P = 0.0001), C-reactive protein (P = 0.03), and lactate level (P = 0.01) were increased by GnRH compared with placebo infusions.<\/jats:p><jats:p>In conclusion, hypogonadotropic hypogonadism in prolonged critically ill men is only partially overcome with exogenous iv GnRH pulses, pointing to combined hypothalamic-pituitary-gonadal origins of the profound hypoandrogenism evident in this context. In view of concomitant central hyposomatotropism and hypothyroidism, evaluating the effectiveness of pulsatile GnRH intervention together with GH and TSH secretagogues will be important.<\/jats:p>","DOI":"10.1210\/jcem.86.7.7680","type":"journal-article","created":{"date-parts":[[2014,1,8]],"date-time":"2014-01-08T17:07:11Z","timestamp":1389200831000},"page":"3217-3226","source":"Crossref","is-referenced-by-count":4,"title":["Five-Day Pulsatile Gonadotropin-Releasing Hormone Administration Unveils Combined Hypothalamic-Pituitary-Gonadal Defects Underlying Profound Hypoandrogenism in Men with Prolonged Critical Illness1"],"prefix":"10.1210","volume":"86","author":[{"given":"Greet","family":"Van den Berghe","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine (G.V.d.B., F.W., P.W.), B-3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Weekers","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine (G.V.d.B., F.W., P.W.), B-3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert C.","family":"Baxter","sequence":"additional","affiliation":[{"name":"Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney University (R.C.B.), St. Leonards, New South Wales 2065, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pieter","family":"Wouters","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine (G.V.d.B., F.W., P.W.), B-3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Iranmanesh","sequence":"additional","affiliation":[{"name":"Endocrine Section, Medical Service, Salem Veterans Affairs Medical Center (A.I.), Salem, Virginia 24153"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Bouillon","sequence":"additional","affiliation":[{"name":"Laboratory for Experimental Medicine 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