Serum level of testosterone, dihydrotestosterone and IGF-1 during an acute exacerbation of COPD and their relationships with inflammatory and prognostic indices: a pilot study

AIM: Acute exacerbations (AECOPD) of negatively influence the natural history of chronic obstructive pulmonary (COPD) and they are related to muscle dysfunction. In this pathway hypogonadism could play a pivotal role. Our study wants to evaluate possible relationships among prognostic indexes of AECOPD, represented by Acute Physiology and Chronic Health Evaluation (APACHE) II, inflammation (serum amyloid A, SSA) and anabolic hormones, especially less studied steroids, like dihydrotestosterone (DHT) e free-testosterone (f-T). METHODS: Twenty-four patients (17 males; age 75±13 yrs) were studied. On admission and at discharge a blood sample for total testosterone (T), DHT, insulin like grow factor 1 (IGF-1) and Serum Amyloid A (SSA) was obtained. f-T was calculated using Vermeulen's formula. RESULTS: Descriptive statistical analysis shows reduced of T values (1.85±2.28 ng/mL), f-T (0.028±0.030 ng/mL), DHT (0.18±0.19 ng/mL) and IGF-1 (91.840±74.19 pg/mL). Calculating tertile for Apache II and SSA and using them as cut off point, three categories were made and used in the analysis (SSA<10 mg/mL; 10-160 mg/mL; >160 mg/mL); (APACHE II≤10; 11-12; >12). Using this classification, an inverse correlation between SAA and T (P=0.01), f-T (0.01), DHT (0.001) and IGF-1 (P=0.05) was found. Data show the same inverse relationship between APACHE II tertiles on one hand and T (P=0.01) and f-T (P=0.02) on the other hand. CONCLUSION: Our data confirm systemic effects of AECOPD and the role of endocrinological derangements, suggesting a possible mechanism explaining them.