Androgens and erythropoiesis: past and present.

Association between androgens and erythropoiesis has been known for more than seven decades. Androgens stimulate hematopoietic system by various mechanisms. These include stimulation of erythropoietin release, increasing bone marrow activity and iron incorporation into the red cells. Before the discovery of recombinant erythropoietin (rhEpo), androgens were used in the treatment of anemia associated with renal disease, bone marrow suppression, and hypopituitarism. Anabolism is an additional advantage of androgen therapy. Furthermore, in light of recent reports regarding adverse effects of rhEpo, the role of androgen therapy in various types of anemias should be readdressed. Polycythemia remains a known side effect of androgen therapy. In this review, we will briefly discuss the initial animal and human studies which demonstrated the role of androgens in the treatment of anemia, their mechanism of action, a detailed account of the efficacy of androgens in the treatment of various anemias, the erythropoietic side effects of androgens and finally, the relationship between hematocrit levels and cardiovascular disease.

Lipoprotein profile in men with prostate cancer undergoing androgen deprivation therapy.

Sex steroids are known to modulate serum lipoproteins. Studies have suggested that serum testosterone levels are associated with a beneficial lipid profile. Androgen deprivation therapy (ADT) is employed in the treatment of recurrent and metastatic prostate cancer (PCa), resulting in profound hypogonadism. As male hypogonadism unfavorably influences lipid profile and men with PCa have high cardiovascular mortality, we evaluated the effects of long-term ADT on fasting lipids. This Cross-sectional study was conducted in a university-based research institution. We evaluated 44 men, 16 undergoing ADT for at least 12 months before the study (ADT group), 14 age-matched eugonadal men with non-metastatic PCa who were status post prostatectomy and/or radiotherapy and not on ADT (non-ADT group) and 14 age-matched eugonadal controls (Control group). None of the men had known history of diabetes or dyslipidemia. Mean age was similar in the three groups (P = 0.37). Serum total (P < 0.01) and free (P < 0.01) testosterone levels were lower in the ADT group compared to the other groups. Men on ADT had higher body mass index (BMI) compared to the other groups (P < 0.01). Men in the ADT group had significantly higher levels of total cholesterol compared to the other two groups (P = 0.03). After adjustment for BMI, men on ADT continued to have significantly higher fasting levels of total cholesterol (P = 0.02), LDL cholesterol (P = 0.04) and non-HDL cholesterol (P = 0.03) compared to the control group. No significant differences were seen in the levels of other lipoproteins between the three groups. These data show that men undergoing long-term ADT have higher total and LDL cholesterol than age-matched controls. Long-term prospective studies are needed to determine the time of onset of changes in these lipoproteins while on ADT and the influence of these changes on cardiovascular mortality.

Interferon-alpha-induced transient severe hypothyroidism in a patient with Graves' disease.

Interferons (IFNs) are proteins with anti-viral activity and are widely used in the treatment of patients with chronic hepatitis C virus (HCV) infection. The use of IFNs has resulted in thyroid dysfunction in a variety of ways. We report a case of a woman with hyperthyroidism due to Graves' disease who developed significant hypothyroidism during treatment with IFN-alpha 2a for HCV infection. However, after discontinuation of IFN-alpha 2a, hyperthyroidism recurred. Potential mechanisms by which IFNs influence thyroid function are discussed.

Necrobiosis lipoidica diabeticorum: response to pentoxiphylline.

Necrobiosis lipoidica diabeticorum (NLD) is a condition that can be physically and psychologically distressing. Angiopathy leading to thrombosis and occlusion of the cutaneous vessels has been implicated in its etiology. Pentoxiphylline is a hemorrheological agent that improves blood flow and decreases red cell and platelet aggregation. Based on these data, aim of our study was to report clinical course of a 20-yr-old diabetic woman with NLD during therapy with Pentoxiphylline 400 mg 3 times daily. After 1 month of therapy, the lesions stopped enlarging. After 3 months, the lesions showed initial signs of healing. At 6-month follow-up, there was near resolution of the lesions. The patient continued therapy and remained in remission at 2-yr follow-up. This improvement relieved psychological stress on the patient. No side effects of treatment were reported. In conclusion, patients with NLD may benefit from treatment with pentoxiphylline. We recommend therapy with 400 mg 3 times daily. The drug should be continued for at least 6 months.