Adrenal androgens and illness

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Abstract
We have studied the adrenal androgen status of medically ill patients, patients before and after cholecystectomy and during recovery from burns injuries. In patients ill for less than 2 weeks, serum androstenedione concentrations (mean .+-. SEM) were raised (7.94 .+-. 0.98 nmol/l) as compared with a control group (4.83 .+-. 0.38 nmol/l, P < 0.005) or with patients ill for more than 2 weeks (5.21 .+-. 0.46 nmol/l P < 0.02); Serum dehydroepiandrosterone sulphate (DHAS) levels were lower in patients ill for more than 2 weeks (1.21 .+-. 0.42 .mu.mol/l) than in either the acutely ill group (5.98 .+-. 1.06 .mu.mol/l, P < 0.001) or the control ill group (5.56 .+-. 0.59 .mu.mol/l, P < 0.001). In post-operative patients serum DHAS levels fell to below pre-operative levels reaching a nadir at day 8 (0.54 .+-. 0.19 vs 1.66 .+-. 0.56 .mu.mol/l, P < 0.02). In burned patients serum cortisol levels were increased on admission (661 .+-. 91 vs 359 .+-. 30 nmol/l, P < 0.005) and remained high over the study period. Serum androstenedione concentrations were also high on admission (7.5 .+-. 1.0 vs 3.9 .+-. 0.3 nmol/l, P < 0.02). Serum DHAS concentrations were similar to control values on admission (6.8 .+-. 1.2 vs 5.2 .+-. 0.7 .mu.mol/l), fell to low levels thereafter reaching a nadir during week 3 (1.6 .+-. 0.6 .mu.mol, P < 0.001). Steroid synthesis in times of chronic illness may be diverted from adrenal androgen to corticosteroid pathways ensuring maintained secretion of cortisol, which is essential to the health of ill patients.