Assessment of Sex Hormones (FSH, LH, Prolactin, Estrogen, Progesterone and Testosterone) of Pulmonary Tuberculosis Patients

Airhomwanbor KO¹, Iyevhobu KO^2,3*, Omolumen LE¹, Asibor E⁴, Obohwemu KO⁵, Usiobeigbe OS¹ , Akindele IA⁶ , Bisiriyu AH⁷, Oikerhe EG⁸, Ajayi FO⁹, Lagundoye SB¹⁰, Uwaifo NE¹¹, Osaiyuwu OF¹², Osaiyuwu OC¹³, Jabbo AA¹⁴, Edo EO¹⁴

¹Department of Chemical Pathology, Faculty of Medical Laboratory Science, Ambrose Alli University, Ekpoma, Edo State, Nigeria
²Department of Medical Microbiology, Faculty of Medical Laboratory Science, Ambrose Alli University, Ekpoma, Edo State, Nigeria
³St Kenny Research Consult, Ekpoma, Edo State, Nigeria
⁴Department of Histopathology and Cytopathology, Faculty of Medical Laboratory Science, Ambrose Alli University, Ekpoma, Edo State, Nigeria
⁵Department of Health, Wellbeing and Social Care, Global Banking School/Oxford Brookes University, Birmingham, United Kingdom
⁶Department of Medical Microbiology, Lead City University, Ibadan, Oyo State, Nigeria
⁷Nigeria Field Epidemiology and Laboratory Training Program (NFELTP), Nigeria
⁸Department of Haematology and Blood Transfusion Science, Faculty of Medical Laboratory Science, Ambrose Alli University, Ekpoma, Edo State, Nigeria
⁹Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP), Abuja, Nigeria
¹⁰Department of Medical Laboratory Science, Federal Medical Centre, Owo, Ondo State, Nigeria
¹¹Department of Medical Laboratory Services (Chemical Pathology), Igbinedion University Teaching Hospital, Okada, Edo State, Nigeria
¹²Department of Chemical Pathology, Faculty of Health Sciences, College of Health Sciences, Igbinedion University, Okada, Edo State, Nigeria
¹³Department of Medical Laboratory Science, Igbinedion University, Okada, Edo State, Nigeria
¹⁴National Ear Care Centre, Kaduna, Kaduna State, Nigeria

*Correspondence author: Iyevhobu Kenneth Oshiokhayamhe, Department of Medical Microbiology, Faculty of Medical Laboratory Science, Ambrose Alli University, Ekpoma, Edo State, Nigeria and St Kenny Research Consult, Ekpoma, Edo State, Nigeria; Email: [email protected]

Copyright^© 2024 by Airhomwanbor KO, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation: Airhomwanbor KO, et al. Assessment of Sex Hormones (FSH, LH, Prolactin, Estrogen, Progesterone and Testosterone) of Pulmonary Tuberculosis Patients. Jour Clin Med Res. 2024;5(3):1-12.

Table 1: Follicle Stimulating Hormone, Luteinizing Hormone, Prolactin, Estrogen, Progesterone and Testosterone in Pulmonary tuberculosis subjects and control.

Table 2: Post-Hoc analysis for table 1 showing ANOVA statistics for various levels of FSH, LH, Prolactin, Estrogen, Progesterone and Testosterone in pulmonary tuberculosis patients.

Relationship between FSH, LH, Prolactin, Estrogen, Progesterone and Testosterone in pulmonary tuberculosis subjects using Pearson Correlation. Table 3 showed the relationship between FSH, LH, Prolactin, Estrogen, Progesterone and Testosterone in Pulmonary tuberculosis subjects using Pearson correlation. The results obtained showed that FSH had a positive correlation with LH (p=0.000) and Estrogen (p=0.558), but had a negative correlation with Progesterone (p=0.000), Prolactin (p=0.554) and Testosterone (p=0.027) respectively. LH had a negative correlation with Prolactin (p=0.804), Progesterone (p=0.000) and Testosterone (p=0.035), but had a positive correlation with Estrogen (p=0.220) respectively. Prolactin had negative correlation with Estrogen (p=0.049) and Testosterone (p=0.369), but had positive correlation with Progesterone (p=0.266). Furthermore, Estrogen had negative correlation with Progesterone (p=0.500) and Testosterone (p=0.332), while Progesterone had positive correlation with Testosterone (p=0.026) respectively.

Table 3: Relationship between FSH, LH, Prolactin, Estrogen, Progesterone and Testosterone in pulmonary tuberculosis subjects using Pearson Correlation.

FSH, LH, Prolactin, Estrogen, Progesterone and Testosterone in pulmonary tuberculosis male and female subjects. Table 4 showed the Follicle Stimulating Hormone, Luteinizing Hormone, Prolactin, Estrogen, Progesterone and Testosterone in pulmonary tuberculosis male and female subjects. The results obtained showed that the FSH (mIU/ml) of male subjects and female subjects was 11.81±2.97 and 15.11±3.24, LH (mIU/ml) was 8.78±1.86 and 11.92±2.75, Prolactin (µg/L) was 6.92±2.90 and 12.46±3.02, Estrogen (pg/ml) was 31.61±6.98 and 41.86±9.19, Progesterone was 0.14±0.04 and 0.19±0.03, and Testosterone (ng/ml) was 2.77±0.99 and 2.14±0.74 respectively. FSH, LH, Prolactin, Estrogen and Progesterone were significantly higher (p<0.05) in female subjects compared with male subjects, while Testosterone was non-significantly (p>0.05) higher in male subjects compared with female subjects.

Table 4: FSH, LH, Prolactin, Estrogen, Progesterone and Testosterone in pulmonary tuberculosis male and female subjects.

FSH, LH, Prolactin, Estrogen, Progesterone and Testosterone in pulmonary tuberculosis subjects with respect to age. Fig. 1 showed the FSH, LH, Prolactin and Testosterone in pulmonary tuberculosis subjects with respect to age. The FSH (mIU/ml) of the subjects in age group 18-25 years, 26-40 years and 41-55 years was 10.66±2.27, 13.77±2.72 and 17.64±2.13, LH (mIU/ml) was 9.25±3.44, 10.31±1.74 and 12.73±2.79, Prolactin (µg/L) was 8.52±3.05, 11.50±3.78 and 10.14±5.38, and Testosterone (ng/ml) was 2.65±1.27, 2.58±0.64 and 2.21±0.89 respectively. Fig. 2showed that the estrogen (pg/ml) of the subjects in age group 18-25 years, 26-40 years and 41-55 years was 39.82±11.25, 33.00±4.67 and 36.29±10.05 respectively. Fig. 3 showed that the Progesterone (ng/ml) of the subjects in age group 18-25 years, 26-40 years and 41-55 years was 0.19±0.06, 0.18±0.04 and 0.20±0.07 respectively. There was no significant difference (p>0.05) in LH, Prolactin, Testosterone, Estrogen and Progesterone of the subjects with respect to age, but there was significant difference (p<0.05) in FSH of the subjects with respect to age. 

Figure 1: FSH, LH, Prolactin and Testosterone levels in Pulmonary tuberculosis patients with respect to age.

Figure 2: Estrogen level is Pulmonary tuberculosis patients with respect to age.

Figure 3: Progesterone level in Pulmonary tuberculosis patients with respect to age.

Discussion

TB is a one of the major global health problems ranking as the eighth leading cause of death in low- and middle-income countries (seventh for men and ninth for women); among adults aged 15-59 years, it ranks as the third cause of death, after HIV/AIDS and ischemic heart disease [20,21]. This study was carried out to evaluate the Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Prolactin, Estrogen, Progesterone and Testosterone of pulmonary tuberculosis patients in Edo State.

In this study, serum FSH and LH levels were statistically significantly higher (p<0.05) in the TB group as compared to controls, while the serum progesterone and estrogen levels were significantly (p<0.05) low in TB cases. This finding is in agreement with previous study by Ansari, who reported that Serum FSH and LH levels were statistically significantly higher in the TB group as compared to controls, while the serum progesterone and estradiol levels were significantly low in TB cases (p<0.05). Malhotra et al. (2012) in a study on the effects of TB on ovarian reserve in females undergoing IVF treatment observed FSH levels to be statistically significantly high in TB cases (p<0.05). Our findings were also consistent with those published by Gurgan et al, (1996) and Doaa et al, (2019) who reported that the mean values of FSH and LH were higher in TB positive.

In this study, the mean serum progesterone and estrogen levels were statistically significantly low in the TB group than in the controls. While mean serum FSH and LH levels were statistically significantly high in healthy individuals, FSH and LH levels are high in the follicular phase and peak at the mid-cycle to facilitate ovulation, whereas progesterone and E2 levels are increased in the luteal phase. Disturbance in the hormonal level balance causes irregularities and can affect the reproductive capabilities of the females. A reduction in serum levels of progesterone in the luteal phase can result in spontaneous abortion [22]. Amenorrhoea or other menstrual cycle abnormalities are caused due to hypogonadism and may significantly affect the fertility of TB sufferers [19]. Ukibe, et al., assessed the hormonal changes in the menstrual cycle in 67 women suffering from TB and observed serum levels of FSH and LH to be at high levels while progesterone and E2 to be significantly low in females diagnosed with pulmonary TB [22,23]. Doaa, et al., and Ansari also reported similar findings [14,24].

The appreciation in the level of progesterone in TB subjects on therapy suggests stimulatory effects of the treatment on the gonads with intact negative feedback mechanism thereby resulting in the restoration of the gonadal functions showing some beneficial effects and a tendency to return to normal. This may reduce the incidence of menstrual abnormality and infertility. Unfortunately however, studies have reported that prolonged use of TB therapy especially protease inhibitors have been associated with other problems such as hyper prolactinaemia [25]. Hyper-prolactinaemia has been associated with increased incidence of anovulation and hence infertility [26].

In this study, Prolactin and Testosterone were statistically significantly lower (p<0.05) in the TB group as compared to controls. This is consistent with previous study by Kranti, et al., who reported that serum Prolactin and Testosterone were statistically significantly lower (p<0.05) in the TB group as compared to controls [27]. Menstrual disturbances in patients with PTB without involvement of ovary or genital system are poorly understood which may be related to disease severity. The other additional factor may be changes in hormonal profile and antigonadotrophic effects of Mycobacterium tuberculosis, which have been observed in these patients; all increase incidence of menstrual abnormality [24,25].

The significantly lower level of testosterone observed in TB female subjects on drugs when compared to Control females are also due to the reduced ovarian function. In normal physiology, testosterone is produced by the ovaries in the females in very small quantities which serve to maintain muscle mass and hence prevents weight loss. In diseased individuals, this quantity becomes much smaller because of reduced ovarian function and is not able to achieve its physiological function anymore hence the excess weight loss that is associated with these diseases (TB inclusive) [25].

FSH, LH, Prolactin, Estrogen and Progesterone were significantly higher (p<0.05) in female subjects compared with male subjects, while Testosterone was non-significantly (p>0.05) higher in male subjects compared with female subjects. More than 70% of individuals who develop active TB are males and wide epidemiological studies in endemic areas from developing countries have shown that males suffer more severe disease, higher rates of recent transmission, more reactivation of latent infection and poorer treatment outcomes [26]. These differences have been attributed to socioeconomic and cultural factors leading to barriers in accessing health care systems, which might cause under notification in women [27,28]. The differences in TB rates between females and males have also been attributed to biological factors [29]. In this regard, polymorphisms or mutations in genes located in chromosome X can confer more TB susceptibility in males, as well as specific features of metabolism and nutrition related to gender, or anatomical and functional differences in the respiratory tract between males and females [30,31]. Nevertheless, perhaps the most important biological factor associated to different TB susceptibility between males and females is the immune regulatory activities of the sexual hormones [32].

FSH, LH, Prolactin, Estrogen and Progesterone were significantly higher (p<0.05) in female subjects compared with male subjects, while Testosterone was non-significantly (p>0.05) higher in male subjects compared with female subjects. More than 70% of individuals who develop active TB are males and wide epidemiological studies in endemic areas from developing countries have shown that males suffer more severe disease, higher rates of recent transmission, more reactivation of latent infection and poorer treatment outcomes [26]. These differences have been attributed to socioeconomic and cultural factors leading to barriers in accessing health care systems, which might cause under notification in women [27,28]. The differences in TB rates between females and males have also been attributed to biological factors [29]. In this regard, polymorphisms or mutations in genes located in chromosome X can confer more TB susceptibility in males, as well as specific features of metabolism and nutrition related to gender, or anatomical and functional differences in the respiratory tract between males and females [30,31]. Nevertheless, perhaps the most important biological factor associated to different TB susceptibility between males and females is the immune regulatory activities of the sexual hormones [32].

Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgement

Acknowledge those who provided technical support during the study.

Financial Disclosure

The corresponding author had no financial support for this article.

Patient Consent

Informed consent for examination and for publishing anonymized data were obtained from the patients.

Data Availability

Data is available for the journal. Informed consents were not necessary for this paper.

Author’s Contribution

The authors contributed equally.

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