Serum androgens in intensive‐care patients: correlations with clinical findings

Serum androgen levels were studied In 100 patients (50 male) with varying degrees ot severe illness, determined by Acute Physiological and Chronic Health Evaluation (APACHE). Comparison with normal subjects revealed the following changes: Basal dehydroeplandrosterone sulphate (DHEAS) values were decreased in the ill female patients (P< 0.001) as well as in the III males (two groups, P<0.01; P<0.05). Androstenedione values did not differ from the controls in patients of either sex. Basal testosterone levels were decreased in ill male patients (P< 0.001), but not in females. The low testosterone concentrations in the severely ill male patients correlated Inversely with the APACHE score; additionally, a dependence on diagnostic categories could be demonstrated In men, since the lowest values were found in patients suffering from sepsis or liver cirrhosis. Acutely ill males had a moderately decreased testosterone, whereas chronically ill males showed a marked reduction of testosterone compared to the controls. Lowered DHEAS and androstenedione levels could be measured in chronically ill males but not In III females. 17α‐OH‐progesterone and 17α‐OH‐pregnenolone levels in subgroups of the patients suggested a probable enzymatic block In the A5‐pathway of androgen biosynthesis in severe illness. The ratio of 17α‐OH‐pregnenolone to DHEAS was significantly higher in male patients and tended to be high in ill females, whereas the ratio of 17α‐OH‐progesterone to androstenedione showed no difference between healthy and ill subjects.