Hypogonadism in patients with chronic obstructive pulmonary disease: relationship with airflow limitation, muscle weakness and systemic inflammation

Abstract

Objectives: To determine the prevalence of hypogonadism in male patients with Chronic obstructive pulmonary diseases (COPD), and to study its impact on skeletal muscle dysfunction and assess the effect of systemic markers of inflammation on testosterone level and muscle function. The study included 50 stable male COPD patients and 30 controls.

Methods: Both groups were subjected to the following measurements; inflammatory markers levels (high-sensitivity C-reactive protein (hs CRP) and interleukin – 6 (IL-6)), sex hormones including; serum total (T) and free testosterone (FT), sex hormone binding globulins (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and 17b estradiol levels (E2), the exercise capacity (6-minute walk distance (6MWT)) and quadriceps muscle force (One repetition maximum (1RM) and EMG). COPD patients underwent spirometry.

Results: There was a higher prevalence of hypogonadism in COPD patients than the controls (62% versus 17%). There was a significant negative correlation between serum testosterone levels (T and FT) and the severity of airway obstruction. Quadriceps muscle force and the exercise capacity were significantly lower in COPD patients than controls but they showed no correlation with the testosterone level. Inflammatory markers were significantly higher in COPD patients compared to controls and showed a significant correlation with the severity of airflow obstruction. The higher inflammatory markers levels were related to more muscle weakness as hs-CRP was inversely correlated with the quadriceps strength and exercise capacity, while IL-6 was inversely correlated to quadriceps strength only.

Conclusion: Hypogonadism is highly prevalent in clinically stable COPD patients and is particularly related to the severity of the airway obstruction. Systemic inflammation is present in stable COPD patients and its intensity is related to the severity of the underlying disease and it predisposes to skeletal muscle weakness and exercise intolerance. However, we failed to find a significant association between hypogonadism and muscle weakness or systemic inflammation.

Keywords: Chronic obstructive   pulmonary diseases; Hypogonadism; Quadriceps muscle weakness; Systemic inflammation; Airflow obstruction; Exercise capacity