Adrenal androgens and illness

We have studied the adrenal androgen status of medically ill patients, patients before and after cholecystectomy and during recovery from burns injury. 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 μmol/l) than in either the acutely ill group (5.98 ± 1.06 μmol/l, P < 0.001) or the control ill group (5.56 ± 0.59 μmol/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 μmol/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 μmol/l), fell to low levels thereafter reaching a nadir during week 3 (1.6 ± 0.6 μmol/l, 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.