[Evaluation of sexual issues by professionals who assist type 2 diabetic men]. / Evaluación de temas sexuales por profesionales que asisten a hombres con diabetes tipo 2.

INTRODUCTION: Our objective was to assess whether physicians who care for people with type 2 diabetes address andrological symptoms such as erectile sexual dysfunction, decreased libido, and symptoms and/or signs of hypogonadism. METHODS: An anonymous survey was carried out with 171 doctors, 113 were females (66.1%), the mean age was 46 ± 10 years (females: 45 ± 10 and males: 49 ± 10, p = 0.006). RESULTS: There were no differences in responses according to gender. Regarding the presence of erectile sexual dysfunction and/or decreased libido, 44.4% (n = 76) and 55.6% (n = 95) did not ask about them, respectively. In patients with symptoms of hypogonadism, 50.9% (n = 87) did not request a testosterone measurement. Regarding the improvement of the metabolic profile of type 2 diabetes mellitus and sexual symptoms after replacement with testosterone, 65.8% of the respondents answered that both conditions could improve after treatment. In the presence of symptoms compatible with hypogonadism, 74.7% of those surveyed stated that the measurement of testosterone should be performed. A total of 108 (63.2%) showed interest in being trained on topics related to type 2 diabetes and disorders of the sexual sphere. CONCLUSION: A large percentage of physicians who take care of men with type 2 diabetes do not inquire about andrological disorders. It is necessary to raise awareness and train doctors to detect, treat and/or refer these frequent health problems, not only to improve the quality of life of patients but also to effectively respond and prevent a major health problem.

Introducción: Los trastornos andrológicos son frecuentes en varones con diabetes tipo 2. El objetivo fue evaluar si los médicos que atienden a personas con diabetes tipo 2 abordan problemas andrológicos como disfunción sexual eréctil, disminución de libido y síntomas de hipogonadismo. Métodos: Se llevó a cabo una encuesta anónima a 171 médicos, de ellos 113 fueron mujeres (66.1%) con una edad media de 46 ± 10 años (mujeres: 45 ± 10 y varones: 49 ± 10, p = 0.006). Resultados: No hubo diferencias en las respuestas según el género. El 44.4% (n = 76) y el 55.6% (n = 95) no preguntan sobre la presencia de disfunción sexual eréctil y/o disminución de libido, respectivamente. El 50.9% (n = 87) no solicitó medición de testosterona en pacientes con síntomas de hipogonadismo. El 65.8% de los participantes respondió que el reemplazo con testosterona puede mejorar el perfil metabólico de la diabetes mellitus tipo 2 y los síntomas sexuales. El 74.7% de los encuestados afirmó que la medición de testosterona debería realizarse ante la presencia de síntomas compatibles con hipogonadismo. El 63.2% (n = 108) mostró interés en formación sobre temas relacionados a diabetes tipo 2 y trastornos de la esfera sexual. Conclusión: Un gran porcentaje de médicos que asisten a varones con diabetes tipo 2 no indaga sobre trastornos andrológicos. Es necesario concientizar y entrenar a los médicos, para detectar, tratar y/o derivar estos problemas de salud tan frecuentes, no solo para mejorar la calidad de vida de los pacientes sino para responder y prevenir efectivamente a un problema mayor de salud.

Evaluación de temas sexuales por profesionales que asisten a hombres con diabetes tipo 2 / Evaluation of sexual issues by professionals who assist type 2 diabetic men

Resumen Introducción: Los trastornos andrológicos son frecuentes en varones con diabetes tipo 2. El objetivo fue evaluar si los médicos que atienden a personas con diabetes tipo 2 abordan problemas andro lógicos como disfunción sexual eréctil, disminución de libido y síntomas de hipogonadismo. Métodos: Se llevó a cabo una encuesta anónima a 171 médicos, de ellos 113 fueron mujeres (66.1%) con una edad media de 46 ± 10 años (mujeres: 45 ± 10 y varones: 49 ± 10, p = 0.006). Resultados: No hubo diferencias en las res puestas según el género. El 44.4% (n = 76) y el 55.6% (n = 95) no preguntan sobre la presencia de disfunción sexual eréctil y/o disminución de libido, respectivamente. El 50.9% (n = 87) no solicitó medición de testosterona en pacientes con síntomas de hipogonadismo. El 65.8% de los participantes respondió que el reemplazo con testosterona puede mejorar el perfil metabólico de la diabetes mellitus tipo 2 y los síntomas sexuales. El 74.7% de los encuestados afirmó que la medición de testosterona debería realizarse ante la presencia de síntomas compatibles con hipogonadismo. El 63.2% (n = 108) mostró interés en formación sobre temas relacionados a diabetes tipo 2 y trastornos de la esfera sexual. Conclusión: Un gran porcentaje de médicos que asisten a varones con diabetes tipo 2 no indaga sobre trastornos andrológicos. Es necesario concientizar y entrenar a los médicos, para detectar, tratar y/o derivar estos problemas de salud tan frecuentes, no solo para mejorar la calidad de vida de los pacientes sino para responder y prevenir efectivamente a un problema mayor de salud.

Abstract Introduction: Our objective was to assess whether physicians who care for people with type 2 dia betes address andrological symptoms such as erectile sexual dysfunction, decreased libido, and symptoms and/ or signs of hypogonadism. Methods: An anonymous survey was carried out with 171 doctors, 113 were females (66.1%), the mean age was 46 ± 10 years (females: 45 ± 10 and males: 49 ± 10, p = 0.006). Results: There were no differences in responses according to gender. Regarding the presence of erectile sexual dysfunction and/or decreased libido, 44.4% (n = 76) and 55.6% (n = 95) did not ask about them, respectively. In patients with symptoms of hypogonadism, 50.9% (n = 87) did not request a testosterone measurement. Regarding the improvement of the metabolic profile of type 2 diabetes mellitus and sexual symptoms after replacement with testosterone, 65.8% of the respondents answered that both conditions could improve after treatment. In the presence of symptoms compatible with hypogonadism, 74.7% of those surveyed stated that the measurement of testosterone should be performed. A total of 108 (63.2%) showed interest in being trained on topics related to type 2 diabetes and disorders of the sexual sphere. Conclusion: A large percentage of physicians who take care of men with type 2 diabetes do not inquire about andrological disorders. It is necessary to raise awareness and train doctors to detect, treat and/or refer these frequent health problems, not only to improve the quality of life of patients but also to effectively respond and prevent a major health problem.

Síndrome hipoglucémico asociado a tumor solitario pulmonar. Reporte de caso / Severe hypoglycemia associated with solitary pulmonary tumor. Case report

El síndrome paraneoplásico de Doege-Potter (SDP) se asocia a la presencia de tumores intratorácicos y diafragmáticos que generan un cuadro de hipoglucemia por excesivo consumo de glucosa por parte del tumor, y aumento de producción de IGF-2 (insulin growth factor 2) con mayor captación de glucosa periférica. Comunicamos el caso de una paciente femenina de 57 años, sin antecedentes de diabetes ni ingestión de fármacos hipoglucemiantes, que ingresó por un cuadro de hipoglucemia severa con glucemia de 38 mg/dL. Otros resultados: péptido C 1,05 ng/mL, insulinemia 10,5 uUI/mL, IGF-1 de 174 ng/mL, cortisol y prolactina normales. No disponíamos del dosaje de IGF-2. Ecografía abdominal sin patología evidente. Se inició alimentación rica en carbohidratos complejos. Continuó con hipoglucemias. A raíz de cervicalgia, se solicitó radiografía cervical y de tórax, evidenciándose opacidad en vértice izquierdo. La tomografía de tórax informó proceso pulmonar atípico. Por punción se diagnosticó carcinoma pulmonar pobremente diferenciado. Se inició quimioterapia, con reducción del tumor, y de la frecuencia y magnitud de las hipoglucemias. Concluimos que frente a cuadros de hipoglucemia en ausencia de factores causales debería sospecharse la presencia de un SD

Doege-Potter (SDP) is a paraneoplastic syndrome mostly associated with big intrathoracic or diaphragmatic tumors, causing hypoglycemia in non-diabetic patient due to an increased glucose consumption by the tumor cells and excessive production of IGF-2 (insulin growth factor 2). Case report: 57-year-old female patient without diabetes mellitus and not receiving hypoglycemic drugs who was assisted by severe hypoglycemia (38 mg/dL) with the following laboratory tests: C peptide 1.05 ng/mL, 10.5 uIU/mL insulinemia, 174 ng/mL IGF-1, normal cortisol and prolactin. IGF-2 was not available. Non-pathological abdominal ultrasound. In spite of a feeding rich in complex carbohydrate continued with hypoglycaemia. She started with neck pain and a cervical and chest X-ray was requested, which shows opacity in the left vertex. Chest tomography reported atypical lung process. The biopsy reported poorly differentiated carcinoma of the lung. After treatment with chemotherapy a reduction in tumor size and less episodes of hypoglycemia were observed. Conclusion: in the event of recurrent hypoglycaemia and in the absence of known etiologies we should consider the presence of SDP

Efectos del ranelato de estroncio sobre la densidad mineral ósea en hombres / Effect of strontium ranelate on bone mineral density in men

La osteoporosis afecta al 6-7% de la poblaciónmasculina. Es alta la proporción de pacientes confractura osteoporótica sin diagnóstico previo de estaenfermedad. La mortalidad luego de una fracturaes mayor en hombres que en población femenina;a pesar de esto, la mayoría de los pacientes no reciben tratamiento. Los fármacos aprobados, en nuestro medio, para tratar la osteoporosis masculina son:bifosfonatos, teriparatida y ranelato de estroncio. Elobjetivo de este estudio fue evaluar el efecto del ranelato de estroncio sobre la densidad mineral ósea enhombres después de 1 año de tratamiento. Se incluyeron los registros de 20 hombres de 67.8±3.0 años,tratados con ranelato de estroncio (2 g/día) durante 1año. Todos los pacientes presentaban un T-score inferior a -2.5 en cadera o columna vertebral o un T-scoreinferior a -2.0 y factores de riesgo de fractura. Nohubo modificación de parámetros de laboratorio luego del tratamiento (calcemia, calciuria, fósforo sérico,parathormona, 25(OH)vitamina D, fosfatasa alcalinay desoxipiridinolina). Luego de 1 año de tratamiento con ranelato de estroncio se observó incrementode la densidad mineral ósea en columna lumbar:0.953±0.029 versus 0.997±0.030 g/cm2 (p=0.0068),cuello femoral: 0.734±0.013 versus 0.764±0.016 g/cm2 (p=0.0084) y cadera total: 0.821±0.02 versus0.834±0.02 g/cm2 (p=0.0419). Conclusión: luego de1 año de tratamiento el ranelato de estroncio produjoun incremento significativo de la densidad mineralósea en columna lumbar y fémur proximal en hombres con osteoporosis (AU)

Osteoporosis affects 6-7% of the male population. The proportion of patients with fragility fractures but without diagnosis of the disease is high. Mortality after hip fracture is higherin men than in women; in spite of this, mostpatients are left without treatment for osteoporosis. Drugs approved, for the treatment ofosteoporosis in our country are bisphosphonates, teriparatide, and strontium ranelate (SrR).The objective of this study was to evaluate theeffect of SrR on axial BMD in men after one yearof treatment. We obtained pertinent data frommedical registries of 20 men aged 67,8±3,0 years,treated with oral SrR (2 g/day) for 12 months. All patients had a T-score below -2,5 at the hipor the lumbar spine, or a T-score below -2,0and one or more risk factors for fracture. Thelevels of serum calcium, phosphate, alkalinephosphatase, 25-hydroxyvitamin D, or PTH,or urinary calcium and desoxipyridinoline remained unchanged following SrR administration. After treatment with SrR there weresignificant increases in BMD at the lumbarspine: 0,953±0,029 versus 0,997±0,030 g/cm2(p=0,0068), femoral neck: 0,734±0,013 versus 0,764±0,016 g/cm2 (p=0.0084), and total hip: 0,821±0,02 versus 0,834±0,02 g/cm2(p=0,0419). Conclusion: in osteoporotic men,treatment with SrR significantly increases BMDin the lumbar spine and the proximal femur (AU)

Efecto del ranelato de estroncio sobre la densidad mineral ósea en hombres con osteoporosis / Effect of strontium ranelate on bone mineral density in men with osteoporosis

La osteoporosis afecta al 6-7% de la población masculina. Es alta la proporción de pacientes con fracturas sin diagnóstico previo de esta enfermedad. La mortalidad luego de una fractura es mayor en hombres que en población femenina; a pesar de esto, la mayoría de los pacientes no reciben tratamiento. Los fármacos aprobados, en nuestro medio, para tratar la osteoporosis masculina son: bifosfonatos, teriparatida y ranelato de estroncio. El objetivo de este estudio fue evaluar el efecto del ranelato de estroncio sobre la densidad mineral ósea en hombres después de 1 año de tratamiento. Se incluyeron los registros de 20 hombres de 67,8±3,0 años, tratados con ranelato de estroncio (2 g/día) durante 1 año. Todos los pacientes presentaban un T-score inferior a -2,5 en cadera o columna vertebral o un T-score inferior a -2,0 y factores de riesgo de fractura. No hubo modificación de parámetros de laboratorio luego del tratamiento (calcemia, calciuria, fósforo sérico, parathormona, 25(OH)vitamina D, fosfatasa alcalina y desoxipiridinolina) en relación a los basales. Luego del tratamiento con ranelato de estroncio se observó incremento de la densidad mineral ósea en columna lumbar: 0,953±0,029 versus 0,997±0,030 g/cm2 (p=0,0068), cuello femoral: 0,734±0,013 versus 0,764±0,016 g/cm2 (p=0,0084) y cadera total: 0,821±0,02 versus 0,834±0,02 g/cm2 (p=0,0419). Conclusión: el tratamiento con ranelato de estroncio produjo un incremento significativo de la densidad mineral ósea en columna lumbar y fémur proximal en hombres con osteoporosis. (AU)

Osteoporosis affects 6-7% of the male population. The proportion of patients with fragility fractures but without diagnosis of the disease is high. Mortality after hip fracture is higher in men than in women; in spite of this, most patients are left without treatment for osteoporosis. Drugs approved, for the treatment of osteoporosis in our country are bisphosphonates, teriparatide, and strontium ranelate (SrR). The objective of this study was to evaluate the effect of SrR on axial BMD in men after one year of treatment. We obtained pertinent data from medical registries of 20 men aged 67,8±3,0 years, treated with oral SrR (2 g/day) for 12 months. All patients had a T-score below -2,5 at the hip or the lumbar spine, or a T-score below -2,0 and one or more risk factors for fracture. The levels of serum calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D, or PTH, or urinary calcium and desoxipyridinoline remained unchanged following SrR administration. After treatment with SrR there were significant increases in BMD at the lumbar spine: 0,953±0,029 versus 0,997±0,030 g/cm2 (p=0,0068), femoral neck: 0,734±0,013 versus 0,764±0,016 g/cm2 (p=0.0084), and total hip: 0,821±0,02 versus 0,834±0,02 g/cm2 (p=0,0419). Conclusion: in osteoporotic men, treatment with SrR significantly increases BMD in the lumbar spine and the proximal femur. (AU)

Evaluación de la respuesta densitométrica en pacientes con osteoporosis posmenopáusica tratadas con ranelato de estroncio o denosumab / Densitometric response in postmenopausal osteoporosis treated with strontium ranelate or denosumab

Tanto el ranelato de estroncio (RSr) como el denosumab (Dmab) son eficaces en el tratamiento de la osteoporosis (OP) posmenopáusica (PM). El efecto de cada fármaco por separado sobre la densidad mineral ósea (DMO) ha sido estudiado recientemente. Con ambas drogas se observó, al año de tratamiento, un aumento significativo de la DMO en columna lumbar (CL), cuello femoral (CF) y cadera total (CT). En este trabajo comparamos la respuesta densitométrica al año de tratamiento con una y otra droga. Utilizamos los registros de 425 pacientes PMOP tratadas con Dmab y 441 tratadas con RSr. En cada paciente analizamos el porcentaje de cambio; se clasificaron como respondedoras aquellas que mostraron un cambio ≥3%. Adicionalmente se comparó la respuesta en pacientes no previamente tratadas con bifosfonatos (BF-naïve) en comparación con pacientes que habían recibido previamente un BF. Al analizar el grupo completo para Dmab, el porcentaje de pacientes respondedoras fue de 68,4% en CL, 63,3% en CF y 49,3% en CT. Por otro lado, en el grupo de pacientes tratadas con RSr, el porcentaje de respondedoras (53,8% en CL, 40,0% en CF y 35,6% en CT) fue estadísticamente menor. Cuando comparamos la respuesta entre las pacientes BF-naïve que recibieron RSr o Dmab, el Dmab indujo mayor respuesta en CL y CF que el grupo RSr, sin diferencias en CT. Cuando se analizaron los subgrupos BF-previo, las tratadas con Dmab mostraron mayor respuesta en todas las regiones. Conclusión: en pacientes con OP-PM, el tratamiento con Dmab produjo mayores incrementos densitométricos que el RSr, siendo el porcentaje de pacientes respondedoras mayor con Dmab que con RSr. (AU)

Both strontium ranelate (SrR) and denosumab (Dmab) are effective in the treatment of postmenopausal osteoporosis (PMOP). The effect of each drug on bone mineral density (BMD) has been studied separately by us. With both treatments, there was a significant increase after one year of treatment at the lumbar spine (LS) and hip. In this paper we compared the densitometric response after one year of treatment with both drugs used separately. We used the clinical records of 425 PM patients treated with Dmab and 441 treated with SrR. For each patient we analyzed the percentage of change; those who showed a change ≥3% were classified as responders. Additionally, the response was compared in patients not previously treated with bisphosphonates (BP-naïve) compared to patients who had previously received a BP. When analyzing the complete group for Dmab, the percentage of "responders" was 65.2% at the LS, 62.9% at the femoral neck (FN) and 47.4% at the total hip (TH). On the other hand, in the group of patients treated with SrR the percentage of responders (53.8% at the LS, 40.0% at the FN and 35.6% at the TH) was statistically lower. When comparing the response between in BF-naïve patients receiving RSr or Dmab, Dmab induced a greater response at the LS and FN than the RSr group, with no statistical differences at the TH. When the subgroups with prior BP treatment were analyzed, those treated with Dmab showed greater response in all regions. Conclusion: in patients with PMOP treatment with Dmab produced greater densitometric increments than SrR, and the percentage of responders was higher with Dmab than with SrR. (AU)

Vitamin D and male reproductive system.

Vitamin D deficiency is a highly prevalent worldwide condition and affects people of all ages. The most important role of vitamin D is the regulation of intestinal calcium absorption and metabolism of calcium and phosphorus to maintain muscle and bone homeostasis. Furthermore, in recent years it has been discovered that the vitamin D receptor (VDR) is widely distributed in many organs and tissues where vitamin D can perform other actions that include the modulation of the immune response, insulin secretion, anti-proliferative effect on cells of vascular smooth muscle, modulation of the renin-angiotensin-aldosterone system and regulates cell growth in several organs. The VDR is widely distributed in the male reproductive system. Vitamin D induces changes in the spermatozoa's calcium and cholesterol content and in protein phosphorylation to tyrosine/threonine residues. These changes could be involved in sperm capacitation. Vitamin D seems to regulate aromatase expression in different tissues. Studies analyzing seasonal variations of sex steroids in male populations yield conflicting results. This is probably due to the wide heterogeneity of the populations included according to age, systemic diseases and obesity.

Male gonadal axis function in patients with type 2 diabetes.

Patients with type 2 diabetes have lower serum testosterone levels and a higher prevalence of hypogonadism than non-diabetic patients, independently of the metabolic control of disease. The mechanisms underlying a decrease in testosterone might be related to age, obesity and insulin resistance, often present in patients with type 2 diabetes. The increase in estrogens due to higher aromatase enzyme activity in increased adipose tissue might exert negative-feedback inhibition centrally. Insulin stimulates gonadal axis activity at all three levels and therefore insulin resistance might account for the lower testosterone production. Leptin exerts a central stimulatory effect but inhibits testicular testosterone secretion. Thus, resistance to leptin in obese subjects with type 2 diabetes determines lower central effects of leptin with lower gonadotropin-releasing hormone (GnRH) secretion and, on the other hand, hyperleptinemia secondary to leptin resistance inhibits testosterone secretion at the testicular level. However, lower testosterone levels in patients with diabetes are observed independently of age, weight and body mass index, which leads to the assumption that hyperglycemia per se might play a role in the decrease in testosterone. Several studies have shown that an overload of glucose results in decreased serum testosterone levels. The aim of this review is to assess changes in the male gonadal axis that occur in patients with type 2 diabetes.

Strontium ranelate effect on bone mineral density is modified by previous bisphosphonate treatment.

The aim of this study was to evaluate the effect of strontium ranelate (SrR) on bone mineral density (BMD) and bone turnover markers after 1 year of treatment. Additionally, the effect of SrR in bisphosphonate-naïve patients (BP-naïve) compared to patients previously treated with bisphosphonates (BP-prior) was analyzed. This retrospective study included 482 postmenopausal women treated with SrR (2 g/day) for 1 year in ten Argentine centers; 41 patients were excluded due to insufficient data, while 441 were included. Participants were divided according to previous bisphosphonate treatment in two groups: BP-naïve (n = 87) and BP-prior (n = 350). Data are expressed as mean ± SEM. After 1 year of treatment with SrR the bone formation markers total alkaline phosphatase and osteocalcin were increased (p < 0.0001), while the bone resorption marker s-CTX was decreased (p = 0.0579). Also increases in BMD at the lumbar spine (LS, 3.73%), femoral neck (FN, 2.00%) and total hip (TH, 1.54%) [p < 0.0001] were observed. These increments were significant (p < 0.0001) both among BP-naïve and BP-prior patients. Interestingly, the change in BMD after 1 year of SrR treatment was higher in BP-naïve patients: LS: BP-naïve = 4.58 ± 0.62%; BP-prior = 3.45 ± 0.28% (p = 0.078). FN: BP-naïve = 2.79 ± 0.56%; BP-prior = 2.13 ± 0.29% (p = 0.161). TH: BP-naïve = 3.01 ± 0.55%; BP-prior = 1.22 ± 0.27% (p = 0.0006). SrR treatment increased BMD and bone formation markers and decreased a bone resorption marker in the whole group, with better response in BP-naïve patients.

Clinical Presentation of Klinefelter's Syndrome: Differences According to Age.

The aim of the study was to establish the characteristics of presentation of 94 patients with Kinelfelter's syndrome (KS) referred to the endocrinologist at different ages. The diagnosis of KS was more frequent in the age group between 11 and 20 years (46.8%). Most of the patients (83.7%) showed the classic 47,XXY karyotype and 7.1% showed a 47,XXY/46,XY mosaicism. Half of the patients younger than 18 years presented mild neurodevelopmental disorders. The most frequent clinical findings were cryptorchidism in prepubertal patients, and small testes, cryptorchidism, and gynecomastia in pubertal patients. FSH, LH, AMH, and inhibin B levels were normal in prepubertal patients and became abnormal from midpuberty. Most adults were referred for small testes, infertility, and gynecomastia; 43.6% had sexual dysfunction. Testosterone levels were low in 45%. Mean stature was above the 50th percentile, and 62.5% had BMI ≥25.0 kg/m(2). In conclusion, the diagnosis of Klinefelter syndrome seems to be made earlier nowadays probably because pediatricians are more aware that boys and adolescents with neuro-developmental disorders and cryptorchidism are at increased risk. The increasing use of prenatal diagnosis has also decreased the mean age at diagnosis and allowed to get insight into the evolution of previously undiagnosed cases, which probably represent the mildest forms. In adults average height and weight are slightly higher than those in the normal population. Bone mineral density is mildly affected, more at the spine than at the femoral neck level, in less than half of cases.

Addition of metformin to sildenafil treatment for erectile dysfunction in eugonadal nondiabetic men with insulin resistance. A prospective, randomized, double-blind pilot study.

Erection depends largely on the release of nitric oxide (NO) by vascular endothelial cells. Insulin resistance (IR) is a metabolic abnormality that produces endothelial dysfunction characterized by decreased synthesis and release of NO. The aim of this paper is to evaluate the effect of treatment with metformin on the response to sildenafil in patients with erectile dysfunction (ED) and IR enrolled in a prospective, randomized, controlled, double-blind placebo study. We included 30 male patients with ED, IR, and poor response to sildenafil. Exclusion criteria included pharmacologic, anatomic, or endocrine ED; diabetes; prostatic surgery; or chronic illnesses. Erectile function was rated according to the International Index of Erectile Function 5 (IIEF-5); IR was measured by homeostasis model assessment (HOMA; IR = HOMA ≥ 3). Patients were randomized to receive metformin (n = 17) or placebo (n = 13). After treatment with metformin, patients with ED showed a significant increase in IIEF-5 score and a significant decrease in HOMA, both occurring at month 2 (IIEF-5: 17.0 ± 6.0 vs 14.3 ± 3.9, P = .01; HOMA: 3.9 ± 1.6 vs 5.5 ± 2.4, P = .01) to 4 of treatment (IIEF-5: 19.8 ± 3.8 vs 14.3 ± 3.9, P = .005; HOMA: 4.5 ± 1.9 vs 5.5 ± 2.4, P = .04), with no changes in these parameters in patients with ED receiving placebo. Patients treated with metformin had more adverse events than those who received placebo: 61.5% compared with 7.7%, P = .03, respectively. Adverse events were mild, mainly gastrointestinal, and did not cause discontinuation of treatment. Treatment with metformin in patients with ED and poor response to sildenafil reduced the IR and improved erectile function.

[Ultraviolet radiation impact on seasonal variations of serum 25-hydroxy-vitamin D in healthy young adults in Buenos Aires]. / Variaciones estacionales de 25 (OH) vitamina D en jóvenes sanos y su asociación con la radiación ultravioleta en Buenos Aires.

Exposure to sunlight (ES) is the main source of vitamin D. There are few reports regarding the seasonal variations of serum 25(OH) vitamin D in young adults and its correlation with ultraviolet radiation dose (UVRd). Our aims were to determine 25OHD variations in young adults and assess the correlation between 25OHD levels, dietary calcium intake (DCI) and the UVRd. Eighty two healthy volunteers were prospectively studied: 42 women and 40 men. Serum 25OHD, calcium, phosphorus and magnesium were measured at the end of winter and at the end of summer. ES and UVRd were determined hourly in winter and summer. Seasonal variation in serum 25OHD levels was observed with significantly higher levels in summer in both gender. Serum 25OHD <20 ng/ml was more frequently found in winter (42.6% in women and 50% in men). The ES and UVRd were significantly lower in winter vs. summer. ES and UVRd positively correlated with 25OHD only in winter in both men and women. DCI was lower than recommended and did not correlate with 25OHD levels.

Variaciones estacionales de 25 (OH) vitamina D en jóvenes sanos y su asociación con la radiación ultravioleta en Buenos Aires / Ultraviolet radiation impact on seasonal variations of serum 25-hydroxyvitamin D in healthy young adults in Buenos Aires

El estatus de vitamina D depende principalmente de la exposición solar (ES). Son escasos los informes de las variaciones estacionales de 25(OH)vitamina D, 25OHD, en adultos jóvenes y su relación con la dosis de radiación solar ultravioleta (dRUV). El objetivo de este trabajo fue medir variaciones estacionales de 25OHD en adultos jóvenes estableciendo la correlación con la ingesta dietaria de calcio (IDCa) y la dRUV. Se realizó un estudio prospectivo en individuos sanos: 42 mujeres y 40 varones. Se dosaron a fin de invierno y fin de verano: 25OHD, calcio, fósforo y magnesio. Se evaluó ES y dRUV para cada hora del día en invierno y verano. Se observó una variación estacional de 25OHD con valores significativamente mayores en verano tanto en varones como en mujeres. El 42.6% de las mujeres y el 50.0% de los varones tenían 25OHD <20 ng/ml en invierno. La ES y la dRUV fueron significativamente inferiores en invierno que en verano. Sólo en invierno se halló una correlación positiva entre ES y dRUV con 25OHD en ambos sexos. La IDCa fue insuficiente y no correlacionó con 25OHD.

Exposure to sunlight (ES) is the main source of vitamin D. There are few reports regarding the seasonal variations of serum 25(OH) vitamin D in young adults and its correlation with ultraviolet radiation dose (UVRd). Our aims were to determine 25OHD variations in young adults and assess the correlation between 25OHD levels, dietary calcium intake (DCI) and the UVRd. Eighty two healthy volunteers were prospectively studied: 42 women and 40 men. Serum 25OHD, calcium, phosphorus and magnesium were measured at the end of winter and at the end of summer. ES and UVRd were determined hourly in winter and summer. Seasonal variation in serum 25OHD levels was observed with significantly higher levels in summer in both gender. Serum 25OHD <20 ng/ml was more frequently found in winter (42.6% in women and 50% in men). The ES and UVRd were significantly lower in winter vs. summer. ES and UVRd positively correlated with 25OHD only in winter in both men and women. DCI was lower than recommended and did not correlate with 25OHD levels.

Erectile dysfunction, obesity, insulin resistance, and their relationship with testosterone levels in eugonadal patients in an andrology clinic setting.

Erectile dysfunction (ED) is associated with metabolic and endocrine diseases including obesity, metabolic syndrome (MS), and type 2 diabetes mellitus (DM2). Insulin resistance (IR), present in patients with obesity, MS, and DM2, causes disturbances in the signaling pathways required for nitric oxide production, with subsequent endothelial dysfunction. In addition, IR appears to alter testosterone production. We evaluated in eugonadal patients with ED: 1) the presence of obesity and IR, 2) testosterone levels and their association with obesity and IR, and 3) the degree of ED according to the presence of IR. In a prospective study, 78 eugonadal patients with ED (group P) were recruited and compared with 17 men without ED as a control group (group C). Erectile function was evaluated according to the International Index of Erectile Function 5 (IIEF-5). IR was measured by homeostasis model assessment (HOMA). IR was defined as HOMA of 3 or greater. Patients with ED had significantly higher body mass index (BMI), waist circumference (WC), HOMA values, and prevalence of IR when compared with group C. Total (TT) and bioavailable testosterone (BT) levels were lower in group P compared with group C. There was a significant negative correlation between HOMA and IIEF-5, HOMA and TT, WC and IIEF-5, WC and TT, and WC and BT. Group P patients with IR had higher WCs and lower IIEF-5 scores when compared with patients in group P without IR. In conclusion, patients with ED showed a higher BMI, WC, and HOMA and lower levels of TT and BT. There is a negative correlation between erectile function and IR and abdominal obesity. The TT levels are lower in patients with increased BMI, WC, and IR. However, a negative correlation was shown only between BT (biologically active fraction) and abdominal obesity.