Sex hormone alterations and systemic inflammation in chronic obstructive pulmonary disease

Decreased anabolic hormone levels are described in chronic obstructive pulmonary disease (COPD), leading to important clinical consequences. The aim of this study was to evaluate the alterations in sex hormone levels in men with COPD to compare with age-matched control subjects, the determinants of these alterations, the relationship between hypogonadism and markers of systemic inflammation [interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-alpha)] and the androgen status during an acute exacerbation of COPD. A total of 103 COPD patients and 30 control subjects were admitted to the study. 83 stable COPD patients and 30 control subjects were evaluated as outpatients. 20 patients with COPD exacerbation were hospitalised and evaluated before discharge and after 1 month. Testosterone and dehydroepiandrosteronesulphate (DHEAS) levels of both COPD groups were lower than that of the control group. Luteinizing hormone (LH), follicle stimulating hormone (FSH) levels were increased during exacerbation. Testosterone and DHEAS levels increased and LH decreased in follow-up measurements of COPD exacerbation group. Testosterone and DHEAS levels were lower in severe COPD [forced expiratory volume in 1 s (FEV1) < 50%], in patients with severe hypoxaemia (PaO2 < 60 mmHg) and in hypercapnic patients. Circulating IL-6 and TNF-alpha concentrations were higher in both stable and exacerbation phase COPD groups than controls. There was no correlation between sex hormones and TNF-alpha or IL-6. The alterations in sex hormone levels in COPD are particularly related to FEV1, hypoxaemia and hypercapnia. There are significant differences in hormone levels during stable and exacerbation phases of COPD; the hormonal changes are marked during exacerbation and partially regress after 1 month when the disease is stabilised.