Endocrinal disturbances and systemic inflammatiom in chronic obstructive pulmonary disease (COPD)

COPD is no longer considered to affect only the lungs and airways but also the rest of the body. The systemic manifestations of COPD include a number of endocrine disorders such as those involving the pituitary, thyroid, gonads, adrenals and pancreas.The aim of this work is to detect the endocrinal and inflammatory changes in COPD patients during stability of the disease and the effect of acute exacerbation on these changes.Subjects and methodsTwenty acute exacerbated COPD (AECOPD) male patients with acute respiratory failure (ARF) were included in this study as a patient group and a control group which included 10 healthy age-matched males with normal pulmonary functions and without any of the exclusion criteria. For patients enrolled in this study, measurement of serum levels of sex hormones [total testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH)], insulin like growth factor-1 (IGF-1) and C-reactive protein (CRP) were done on admission and 1 month after hospital discharge. For healthy group, the previous measurements were done once only.ResultsThere were statistically significant decrease in serum testosterone and IGF-1 levels in patients after stabilization than those in the control group with more decrease of their levels during exacerbation and the difference between their levels in patients during exacerbation and after stabilization was statistically highly significant. As regards serum LH and FSH, there were statistically highly significant increase in their levels in COPD patients during exacerbation than those in the control group but there were non-significant differences in these hormones levels between the patients after stabilization and the control group. As regards serum CRP, there was highly significant increase in its serum level in patients in both exacerbation and after stabilization than that in the control group. The level of CRP in patients during exacerbation was higher than that after stabilization and the difference was statistically highly significant. As regards disease severity, there were statistically highly significant decrease in testosterone level in severe to very severe COPD patient group than that in mild to moderate one. There was also statistically significant decrease in serum IGF-1 level in severe to very severe COPD patient group than that in mild to moderate one. There was statistically highly significant increase in serum CRP level in severe to very severe COPD patient group than that in mild to moderate one. On the other hand, there was statistically non-significant increase in serum LH and FSH levels in severe to very severe CPOD patient group than those in mild to moderate one. There were statistically highly significant positive correlations between serum testosterone levels and both FEV1% predicted and PaO2. There were also statistically highly significant positive correlations between serum IGF-1 levels and both FEV1% predicted and PaO2 and also between serum CRP levels and PaCO2 in patients during exacerbation. Also during exacerbation, there was statistically highly significant negative correlation between serum CRP levels and FEV1% predicted.ConclusionCOPD leads to alterations in serum levels of sex hormones (testosterone, LH and FSH), IGF-1 and CRP. There was decrease in testosterone hormone levels of male stable COPD patients and this decrease was more evident, with compensatory increase in LH and FSH hormones levels, during exacerbation period when hypoxemia is more significant. CRP level is increased even in stable COPD and this rise is magnified with increased disease severity. IGF-1 decreased in stable COPD patients with more decrease in its level during acute exacerbation.