A Screening Tool to Detect Chronic Critically Ill Cardiac Surgery Patients at Risk for Low Levels of Testosterone and Somatomedin C: A Prospective Observational Pilot Study.

• Type of Material: Article
• Authors: Ceressa T. Ward, Emory University; David W. Boorman, Emory University; Ava Afshar, Emory University; Amit Prabhakar, Emory University; Babar Fiza, Emory University; Laura R. Pyronneau, Consumer Value Stores Pharmacy; Amber Kimathi, Emory University; Carmen Paul, Emory University; Berthold Moser, See-Spital Horgen; Vanessa Moll, Emory University
• Language: English
• Date: 2021-05-28
• Publisher: Cureus
• Publication Version: Final Published Version
• Copyright Statement: © 2021, Ward et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.15298
• Title of Journal or Parent Work: Cureus
• Volume: 13
• Issue: 5
• Start Page: e15298
• End Page: e15298
• Keywords: critical illness; growth hormone; insulin-like growth factor 1; testosterone; somatomedin c
• Research Categories: Biology, Genetics; Biology, Cell

Abstract

Objective The neuroendocrine response to critical illness is dichotomous as it is adaptive during the acute phase then transitions to maladaptive as critical illness becomes prolonged in 25-30% of patients. Presently, monitoring all critically ill patients for endocrinopathies is not the standard of care. However, given the negative impact on patient prognosis, a need to identify those at risk for endocrinopathies, may exist. Thus, a screening tool to identify endocrinopathies along the somatotroph and gonadal axes in a cardiothoracic surgery population was developed. Methods A prospective observational pilot study was conducted in two cardiothoracic surgery intensive care units (ICU) within a multi-site healthcare system. Total testosterone and somatomedin C levels were obtained from 20 adult patients who remained in the ICU for greater than seven days after cardiothoracic surgery and were tolerating nutrition, had a risk of malnutrition and a mobility score of moderate to dependent assistance. Results Twenty patients were included for descriptive analysis (seven females). Thirteen patients tested low for total testosterone, with males more likely to have a testosterone-related endocrinopathy as compared to females (100% vs. 0 to 43%, p = 0.0072). A higher proportion of low somatomedin C levels was found in females than males (57% vs. 31%); however, the difference was not statistically significant (p = 0.251). Conclusions The screening tool used in this pilot study accurately predicted low total testosterone in all men and reasonably predicted low somatomedin C in a majority of women. However, the ability of the tool to predict low total testosterone in women and low somatomedin C in men is less certain. A gender-specific screening tool might be necessary to predict hormonal deficiencies.