The Female Gonadal Response to Critical Disease

  • Mark D. Nixon
  • Robert W. Rebar
Part of the Contemporary Endocrinology book series (COE, volume 4)


Although reproductive changes that occur in women in response to critical disease are poorly detailed in the medical literature, it is possible to consider the spectrum of responses that may result. That these changes do in fact occur is based on anecdotal reports and the experience of clinicians.


Cystic Fibrosis Chronic Renal Failure Primary Biliary Cirrhosis Acquire Immune Deficiency Syndrome Ovarian Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Woolf PD, Hamill RW, McDonald JV, Lee LA, Kelly M. Transient hypogonadotropic hypogonadism caused by critical illness. J Clin Endocrin Metab 1985; 60: 444–450.CrossRefGoogle Scholar
  2. 2.
    Gebhart SS, Watts NB, Clark RV, et al. Reversible impairment of gonadotropin secretion in critical illness. Observations in postmenopausal women. Arch Intern Med 1989; 149: 1637–1641.PubMedCrossRefGoogle Scholar
  3. 3.
    Bing-You RG, Spratt DI. Serum estradiol but not gonadotropin levels decrease acutely after insulin-induced hypoglycemia in cycling women. J Clin Endocrinol Metab 1992; 75: 1054–1059.PubMedCrossRefGoogle Scholar
  4. 4.
    Spratt DI, Cox P, Orav J, et al. Reproductive axis suppression in acute illness is related to disease severity. J Clin Endocrinol Metab 1993; 76: 1548–1554.PubMedCrossRefGoogle Scholar
  5. 5.
    Stellon AJ, Williams R. Increased incidence of menstrual abnormalities and hysterectomy preceding primary biliary cirrhosis. Br Med J 1986; 293: 297–298.CrossRefGoogle Scholar
  6. 6.
    Cundy TF, O’Grady JG, Williams R Recovery of menstruation and pregnancy after liver transplantation. Gut 1990; 31: 337–338.PubMedCrossRefGoogle Scholar
  7. 7.
    Varma RR. Course and prognosis of pregnancy in women with liver disease. Semin Liver Dis 1987; 7 (1): 59–66.PubMedCrossRefGoogle Scholar
  8. 8.
    Mass K, Quint EH, Punch MR, Merion RM. Gynecological and reproductive function after liver transplantation. Transplantation. 1996; 62: 476–479.PubMedCrossRefGoogle Scholar
  9. 9.
    O’Grady JG, Williams R. Postoperative care: long-term. In: Maddey WC, Sorrell M, eds. Transplantation of the Liver, 2nd ed. Appleton and Lange, Norwalk, 1995, pp. 207–224.Google Scholar
  10. 10.
    Ghent CN. Survival following liver transplantation. In: Maddey WC, Sorrell MF, eds. Transplantation of the Liver, 2nd ed. Appleton and Lange, Norwalk, 1995, pp. 541–555.Google Scholar
  11. 11.
    Everhart JE, DiBisceglie AM, Murray LM. Risk for non-A, non-B (type C) hepatitis through sexual or household contact with chronic carriers. Ann Int Med 1990; 112: 544–545.PubMedGoogle Scholar
  12. 12.
    Reinus JF, Leikin EL, Alter HJ. Failure to detect vertical transmission of hepatitis C virus. Ann Intern Med 1992; 117: 881–885.PubMedGoogle Scholar
  13. 13.
    Scantlebury V, Gordon R, Tzakis A. Childbearing after liver transplantation. Transplantation 1990; 49: 317–321.PubMedCrossRefGoogle Scholar
  14. 14.
    Laifer SA, Darby MJ, Scantlebury VP. Pregnancy and liver transplantation. Obstet Gynecol 1990; 76: 1083–1088.PubMedGoogle Scholar
  15. 15.
    Ville Y, Fernandez H, Samuel D, Bismuth H, Frydman R. Pregnancy after hepatic transplantation. J Gynecol Obstet Biol Reprod 1992; 21: 691–696.Google Scholar
  16. 16.
    Handelsman DJ. Hypothalamic-pituitary-gonadal dysfunction in renal failure, dialysis and renal transplantation. Endocr Rev 1985; 6: 151–182.PubMedCrossRefGoogle Scholar
  17. 17.
    Rice GG. Hypermenorrhea in the young hemodialysis patient. Am J Obstet Gynecol 1973; 166: 539–542.Google Scholar
  18. 18.
    Ferraris JR, Domene HM, Escobar ME, Caletti MG, Ramirez JA, Rivarola MA. Hormone profile in pubertal females with chronic renal failure: before and under haemodialysis and after renal transplantation. Acta Endocrinol 1987; 115: 289–296.PubMedGoogle Scholar
  19. 19.
    Lim VS, Henriquez C, Sievertsen, Frohman LA. Ovarian function in chronic renal failure: evidence suggesting hypothalamic anovulation. Ann Intern Med 1980; 93: 21–27.PubMedGoogle Scholar
  20. 20.
    Lim VS, Kathpalia SC, Frohman LA. Hyperprolactinemia and impaired pituitary response to suppression and stimulation in chronic renal failure: reversal after transplantation. J Clin Endocrinol Metab 1979; 48: 101–107.PubMedCrossRefGoogle Scholar
  21. 21.
    Hasegawa K, Matsushita Y, Hirai K, et al. Abnormal response of luteinizing hormone, follicle stimulating hormone, and testosterone to luteinizing hormone-releasing hormone in chronic renal failure. Acta Endocrinol 1978; 87: 467–475.PubMedGoogle Scholar
  22. 22.
    Swamy AP, Woolf PD, Cestero RVM. Hypothalamic-pituitary-ovarian axis in uremic women. J Lab Clin Med 1979; 93: 1066–1072.PubMedGoogle Scholar
  23. 23.
    Pimstone B, Epstein S, Hamilton SM, LeRoith D, Hendricks S. Metabolic clearance and plasma half disappearance time of exogenous gonadotropin releasing hormone in normal subjects and in patients with liver disease and chronic renal failure. J Clin Endocrinol Metab 1977; 44: 356–360.PubMedCrossRefGoogle Scholar
  24. 24.
    Price TM, Dupuis RE, Carr BR, Stanczyk FZ, Lobo RA, Droegemueller W. Single-and multiple-dose pharmacokinetics of a low-dose oral contraceptive in women with chronic renal failure undergoing peritoneal dialysis. Am J Obstet Gynecol 1993; 168: 1400–1406.PubMedGoogle Scholar
  25. 25.
    Davison JM, Lindheimer MD. Renal disorders. In: Creasy RK, Resnik R, eds. Maternal-Fetal Medicine: Principles and Practice, 3rd ed. Saunders, Philadelphia, 1994, pp. 844–864.Google Scholar
  26. 26.
    Hou S. Pregnancy in women with chronic renal disease. N Engl J Med 1985; 312: 836–839.PubMedCrossRefGoogle Scholar
  27. 27.
    Croxson TS, Chapman WE, Miller LK, Levit CD, Senie R, Zumoff B. Changes in the hypothalamicpituitary-gonadal axis in human immunodeficiency virus-infected homosexual men. J Clin Endocrinol Metab 1989; 68: 317–321.PubMedCrossRefGoogle Scholar
  28. 28.
    Raffi F, Brisseau FM, Planchon B, Remi JP, Barrier JH, Grolleau JY. Endocrine function in 98 HIV-infected patients: a prospective study. AIDS. 1991; 5: 729–733.PubMedCrossRefGoogle Scholar
  29. 29.
    Conner EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994; 331: 1173–1180.CrossRefGoogle Scholar
  30. 30.
    Zemlickis D, Lishner M, Degendorfer P, et al. Maternal and fetal outcome after breast cancer in pregnancy. Am J Obstet Gynecol 1992; 166: 781–787.PubMedGoogle Scholar
  31. 31.
    Nugent P, O’Connell TX. Breast cancer and pregnancy. Arch Surg 1985; 120: 1221–1224.PubMedCrossRefGoogle Scholar
  32. 32.
    Ribeiro G, Jones DA, Jones M. Carcinoma of the breast associated with pregnancy. Br J Surg 1986; 73: 607–609.PubMedCrossRefGoogle Scholar
  33. 33.
    Byrne J, Kessler LG, Devesa SS. The prevalence of cancer among adults in the United States, 1987. Cancer 1992; 69: 2154–2159.Google Scholar
  34. 34.
    Damewood MD, Grochow LB. Prospects for fertility after chemotherapy or radiation for neoplastic disease. Fertil Steril 1986; 45: 443–459.PubMedGoogle Scholar
  35. 35.
    Gradishar WJ, Schilsky RL. Effect of cancer treatment on the reproductive system. Crit Rev Oncol Hematol 1988; 8: 153–171.PubMedCrossRefGoogle Scholar
  36. 36.
    Chapman RM, Sutcliffe SB, Malpas JS. Male gonadal dysfunction in Hodgkin’s disease. JAMA 1982; 245: 1323–1328.CrossRefGoogle Scholar
  37. 37.
    Shapiro E, Kinsella TJ, Makuch RW, et al. Effects of fractionated irradiation on endocrine aspects of testicular function. J Clin Oncol 1985; 3: 1232–1239.PubMedGoogle Scholar
  38. 38.
    Gradishar WJ, Schilsky RL. Ovarian function following radiation and chemotherapy for cancer. Semin Oncol 1989; 16: 425–436.PubMedGoogle Scholar
  39. 39.
    Nicholson HS, Byrne J. Fertility and pregnancy after treatment for cancer during childhood or adolescence. Cancer 1993; 71 (10): 3392–3399.PubMedCrossRefGoogle Scholar
  40. 40.
    Jacox HW. Recovery following human ovum irradiation. Radiology 1939; 32: 538–545.Google Scholar
  41. 41.
    Miller RW. Delayed effect occurring within the first decade after exposure of young individuals to the Hiroshima atomic bomb. Pediatrics 1956; 8: 1–17.Google Scholar
  42. 42.
    Kaplan II. The treatment of female sterility with X-ray therapy directed to the pituitary and ovaries. Am J Obstet Gynecol 1958; 76: 447–453.PubMedGoogle Scholar
  43. 43.
    Dickson RJ. The late results of radium treatment for benign uterine haemorrhage. Br J Radiol 1969; 42: 582–594.CrossRefGoogle Scholar
  44. 44.
    Smith PG, Doll R. Late effects of X-irradiation in patients for metropathia haemorrhagica. Br J Radiol 1976; 49: 224–232.PubMedCrossRefGoogle Scholar
  45. 45.
    Ash P. The influence of radiation on fertility in man. Br J Radiol 1980; 53: 271–278.PubMedCrossRefGoogle Scholar
  46. 46.
    Baker TG. Radiosensitivity of mammalian oocytes with particular reference to the human female. Am J Obstet Gynecol 1971; 110: 746–761.PubMedGoogle Scholar
  47. 47.
    Madsen BL, Guidice L, Donaldson SS. Radiation-induced premature menopause: a misconception. Int J Radiat Oncol Biol Phys 1995; 32: 1461–1464.PubMedCrossRefGoogle Scholar
  48. 48.
    Sins EJ, Leventhal BG, Vaitukaitis JI. Effects of childhood leukemia and chemotherapy on puberty and reproductive function in girls. N Engl J Med 1976; 249: 1143–1146.Google Scholar
  49. 49.
    Hamre MR, Robinson LL, Nesbit ME, Sather HN, Meadows AT, Ortega TA. Effects of radiation on ovarian function in long-term survivors of childhood acute lymphoblastic leukemia: a report from the Children’s Cancer Study Group. J Clin Oncol 1987; 5: 1759–1765.PubMedGoogle Scholar
  50. 50.
    Quigley C, Cowell C, Jimenez M, et al. Normal or early development of puberty despite gonadal damage in children treated for acute lymphoblastic leukemia. N Engl J Med 1989; 321: 143–151.PubMedCrossRefGoogle Scholar
  51. 51.
    Himmelstein-Braw R, Peters H, Faber M. Influence of irradiation and chemotherapy on the ovaries of children with abdominal tumors. Br J Cancer 1977; 36: 269–275.CrossRefGoogle Scholar
  52. 52.
    Parsons DF. An electron microscopy study of radiation damage in the mouse oocyte. J Cell Biol 1962; 14: 31–48.PubMedCrossRefGoogle Scholar
  53. 53.
    Ogilvy-Stuart AL, Clark DJ, Wallace WHB, et al. Endocrine deficit after fractionated total body irradiation. Arch Dis Child 1992; 67: 1107–1110.PubMedCrossRefGoogle Scholar
  54. 54.
    Cohen I, Speroff L. Premature ovarian failure update. Obstet Gynecol Survey 1991; 46: 156–162.CrossRefGoogle Scholar
  55. 55.
    Byrne J, Mulvihill JS, Myers MH, et al. Effects of treatments on fertility in long-term survivors of childhood or adolescent cancer. N Engl J Med 1987; 317: 1315–1321.PubMedCrossRefGoogle Scholar
  56. 56.
    Janson PO, Jansson I, Skryten A, et al. Ovarian endocrine function in young women underlying radiotherapy for carcinoma of the cervix. Gynecol Oncol 1981; 11: 218–223.PubMedCrossRefGoogle Scholar
  57. 57.
    Feeney DD, Moore DH, Look KY, Stehman FB, Sutton GP. The fate of the ovaries after radical hysterectomy and ovarian transposition. Gynecol Oncol 1995; 56: 3–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Hodel K, Rich WM, Austin P, DiSaia PJ. The role of ovarian transposition in conservation of ovarian function in radical hysterectomy followed by pelvic radiation. Gynecol Oncol 1982; 13: 195–202.PubMedCrossRefGoogle Scholar
  59. 59.
    Anderson B, Buller R, Turner D, Chapman G Ovarian transposition in cervical cancer. Gynecol Oncol 1992; 45: 81.CrossRefGoogle Scholar
  60. 60.
    Ray GR, Trueblood HW, Enright LD, Kaplan HS, Nelsen TS. Oophoropexy: a means of preserving ovarian function following pelvic megavoltage radiotherapy for Hodgkin’s disease. Radiology 1970; 96: 175–180.PubMedGoogle Scholar
  61. 61.
    Thibaud E, Ramirez M, Brauner R, et al. Preservation of ovarian function by ovarian transposition performed before pelvic irradiation during childhood. J Pediatr 1992; 121: 880–884.PubMedCrossRefGoogle Scholar
  62. 62.
    Ataya K, Pydyn E, Ramahi-Ataya A, Orton CG. Is radiation-induced ovarian failure in rhesus monkeys preventable by luteinizing hormone-releasing hormone agonists?: preliminary observations. J Clin Endocrinol Metab 1995; 80: 790–795.PubMedCrossRefGoogle Scholar
  63. 63.
    Jarrell J, YoungLai EV, McMahon A, Barr R, O’Connell G, Belbeck. Effect of ionizing radiation and pretreatment with [D-leu 6, des Gly 10] luteinizing hormone-releasing hormone ethylamide on developing rat ovarian follicles. Cancer Res 1987; 47: 5005–5008.PubMedGoogle Scholar
  64. 64.
    Horning SJ, Hoppe RT, Kaplan HS, et al. Female reproductive potential after treatment for Hodgkin’s disease. N Engl J Med 1981; 304: 1377–1382.PubMedCrossRefGoogle Scholar
  65. 65.
    Koyama H, Wada T, Nishizawa Y, et al. Cyclophosphamide-induced ovarian failure and its therapeutic significance in patients with breast cancer. Cancer 1977; 39: 1403–1409.PubMedCrossRefGoogle Scholar
  66. 66.
    Stillman RJ, Schinfeld JS, Schiff I, et al. Ovarian failure in long-term survivors of childhood malignancy. Am J Obstet Gynecol 1981; 139: 62–66.PubMedGoogle Scholar
  67. 67.
    Whitehead E, Shalet SM, Blackledge D, et al. The effect of combination chemotherapy on ovarian failure in women treated for Hodgkin’s disease. Cancer 1983; 52: 988–993.PubMedCrossRefGoogle Scholar
  68. 68.
    Green DM, Zevon MA, Lowrie G, Seigelstein N, Hall B. Congenital anomalies in children of patients who received chemotherapy for cancer in childhood and adolescence. N Engl J Med 1991; 325: 141–146.PubMedCrossRefGoogle Scholar
  69. 69.
    Sanders JE, Hawley J, Levy W, et al. Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation. Blood 1996; 87: 3045–3052.PubMedGoogle Scholar
  70. 70.
    Neinstein LS. Issues in Reproductive Management. Thieme Medical, New York, 1994.Google Scholar
  71. 71.
    Seale TW, Flux M, Rennert OM. Reproductive defects in patients of both sexes with cystic fibrosis: A review. Ann Clin Lab Sci 1985; 5: 152–158.Google Scholar
  72. 72.
    Kredentser JV, Pokrant C, McCoshen JA. Intrauterine insemination for infertility due to cystic fibrosis. Fertil Steril 1986; 45: 425–426.PubMedGoogle Scholar
  73. 73.
    Fitzpatrick SB, Stokes DC, Rosenstein BJ, Terry P, Hubbard VS. Use of oral contraceptives in women with cystic fibrosis. Chest 1984; 86: 863–867.PubMedCrossRefGoogle Scholar
  74. 74.
    Baird DD, Narendranathan M, Sandler RS. Increased risk of preterm birth for women with inflammatory bowel disease. Gastroenterology 1990; 99: 987–994.PubMedGoogle Scholar
  75. 75.
    Zeldis JB. Pregnancy and inflammatory bowel disease. West J Med 1989; 151: 168–171.PubMedGoogle Scholar
  76. 76.
    Wikland M, Jansson I, Asztely M, et al. Gynaecological problems related to anatomical changes after convention proctocolectomy and ileostomy. Int J Colorectal Dis 1990; 5: 49–52.PubMedCrossRefGoogle Scholar
  77. 77.
    Lawson DH, Lovatt GE, Gurton CS, Hennings RC. Adverse effects of azathioprine. Adverse Drug React Acute Poisoning Rev 1984; 3: 161–174.PubMedGoogle Scholar
  78. 78.
    Burkart W, Fischer-Guntenhoener E, Standl E, Schneider HP. Menarche, menstrual cycle and fertility in diabetic patients. Geburtshilfe Frauenheilkd 1989; 49: 149–154.PubMedCrossRefGoogle Scholar
  79. 79.
    Moore TR. Diabetes in pregnancy. In: Creasy RK, Resnik R, eds. Maternal-Fetal Medicine: Principles and Practice. Saunders, Philadelphia, 1994, pp. 934–975.Google Scholar
  80. 80.
    Rosenn B, Miodovnik M, Combs CA, Khoury J, Siddiqi TA. Pre-conception management of insulin-dependent diabetes: Improvement of pregnancy outcome. Obstet Gynecol 1991; 77: 846–849.PubMedGoogle Scholar
  81. 81.
    Steel JM, Johnstone FD, Hepburn DA, Smith AF. Can prepregnancy care of diabetic women reduce the risk of abnormal babies? Br Med J 1990; 301: 1070–1074.CrossRefGoogle Scholar
  82. 82.
    Kitzmiller JL, Gavin LA, Gin GD, Jovanovic-Peterson L, Main EK, Zigrang WD. Preconception care of diabetes: Glycemic control prevents congenital anomalies JAMA 1991; 265: 731–736.Google Scholar
  83. 83.
    Speroff L, Darney PD. A Clinical Guide for Contraception, 2nd ed. Williams and Wilkins, Baltimore, 1996, pp. 25–117.Google Scholar
  84. 84.
    Garg SK, Chase HP, Marshall G, Hoops SL, Holmes DL, Jackson WE. Oral contraceptives and renal and retinal complications in young women with insulin-dependent diabetes mellitus. JAMA 1994; 271: 1099–1102.PubMedCrossRefGoogle Scholar
  85. 85.
    Becks GP, Burrow GN. Thyroid disease and pregnancy. Med Clin North Am 1991; 75: 121–150.PubMedGoogle Scholar
  86. 86.
    Seely BL, Burrow GN. Thyroid disease and pregnancy. In: Creasy RK, Resnik R, eds. Maternal-Fetal Medicine: Principles and Practice. Saunders, Philadelphia, 1994, pp. 979–1003.Google Scholar
  87. 87.
    Canobbio MM, Rapkin AJ, Perloff JK, Lin A, Child JS. Menstrual patterns in women with congenital heart disease. Pediatr Cardiol 1995; 16: 12–15.PubMedCrossRefGoogle Scholar
  88. 88.
    Mulligan T, Sheehan H, Hanrahan J. Sexual function after heart transplantation. J Heart Lung Transplant 1991; 10: 125–128.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Mark D. Nixon
  • Robert W. Rebar

There are no affiliations available

Personalised recommendations