Abstract
Background: A large proportion of populations suffer from acute mountain sickness (AMS) after exposure at high altitude. AMS is closely related with age and gender implying that the sex hormones may play critical roles in AMS. Our observational study aimed to identify the association between the endogenous testosterone (T), estradiol (E2) and AMS.Methods: A total of 113 subjects were recruited in 2012. The participants were evaluated at 500 m and after acute (1 day) and short-term (7 days) high-altitude exposure at 3,700 m. The subjects also completed a case report form questionnaire and underwent blood pressure measurements and an echocardiography examination. The red blood cell (RBC) count, Hb concentration ([Hb]), hematocrit (HCT), E2, T, and erythropoietin (EPO) were measured.Results: Upon acute high-altitude exposure, E2 and EPO were significantly lower in AMS+ group, and T/E2 and stroke volume were higher. On the 1st day, AMS score correlated positively with the T/E2 ratio while it negatively correlated with E2. After 7 days at 3,700 m, the AMS+ subjects had higher erythropoietic parameters: EPO, T, and T/E2 were significantly higher in the AMS+ group. [Hb], RBC count, HCT, EPO, T and T/E2 were also correlated with AMS score. EPO, HCT, and the RBC count were also correlated with T/E2. Regression analyses indicated that T/E2 significantly correlated to AMS score and T/E2 on the 1st day was an independent predictor for AMS on the 7th day.Conclusion: AMS was correlated with T/E2 ratio and EPO. After short-term exposure, higher T/E2 may contribute to AMS together with EPO via erythropoiesis. Furthermore, T/E2 level at high altitude in the early stage was an independent predictor for AMS in the latter stage.
Highlights
Acute mountain sickness (AMS) has been defined as a syndrome involving headache, dizziness, gastrointestinal symptoms, insomnia and fatigue after arrival at high-altitude (>2500 m) (Imray et al, 2010; Bartsch and Swenson, 2013)
We found that ejection fraction (EF) and stroke volume (SV) increased after arrival at 3,700 m remained significantly increased after 7 days (Figures 2L,M)
These results partly agree with the previous findings that high serum T and Hb are adequate for acclimatization due to the improvement of oxygen transport, while even higher levels of T and Hb are associated with excessive erythrocytosis (EE) (Gonzales, 2011; Ekart et al, 2013), which may account for the positive relationships between T/E2 ratio and AMS score on the 1st day as well as association of after 7 days of exposure
Summary
Acute mountain sickness (AMS) has been defined as a syndrome involving headache, dizziness, gastrointestinal symptoms, insomnia and fatigue after arrival at high-altitude (>2500 m) (Imray et al, 2010; Bartsch and Swenson, 2013). The respiratory and cardiovascular aspects of AMS have been studied for many years; attention should be given to the endocrine aspects, the effects of sex hormones and hematopoiesis on AMS (Naeije, 2010; Oliver et al, 2012). Testosterone (T) and E2 are the two most active sex hormones and are suggested to participate in AMS, based on the gender differences in the incidence of AMS (Harris et al, 1966; Wu et al, 2012). Our observational study aimed to identify the association between the endogenous testosterone (T), estradiol (E2) and AMS
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