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1.
Mymensingh Med J ; 29(4): 1015-1020, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116111

RESUMO

Hypopituitarism is a rare entity with reported incidence, 4 per 100,000 and about 50% of such patients present with three to five pituitary hormone deficits. A slow onset of symptoms is typical. But, diversified presentations from absence of symptoms to vague clinical features to lethal effects leading to mortality are not uncommon in such disorder. In adults, in such cases symptoms of hypogonadism may be the first noticeable illness for reporting to physicians, but it is often under evaluated or even ignored. Here, we present a case of 40-year-old adult male with panhypopituitarism, who presented with loss of generalized body hair and loss of libido for about last five years but the problem was not evaluated adequately. Later, he developed lethargy, generalized weakness, weight loss and then the underneath cause detected was panhypopituitarism due to pituitary macro adenoma. So, suspicion and hormonal evaluation for hypogonadism would help in early detection and management of progressive hypopituitarism in symptomatic adult patients. Cases of panhypopituitarism need lifelong hormone replacement and follow-up and if pituitary adenoma is present, surgical removal by trans-sphenoidal approach is preferable.


Assuntos
Adenoma , Hipogonadismo , Hipopituitarismo , Neoplasias Hipofisárias , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Adulto , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/etiologia , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiologia , Hipopituitarismo/terapia , Masculino , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia
2.
Lancet HIV ; 7(11): e782-e790, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33128905

RESUMO

The advent of new classes of antiretroviral drugs has improved the survival of people with HIV, and several ageing-related conditions, including hypogonadism and osteoporosis, have emerged. However, both are silent conditions, and are underestimated, underdiagnosed, and not adequately treated. Several factors, including the effects of the virus, antiretroviral therapy, lifestyle factors, and comorbidities, contribute to testicular dysfunction, which in turn has important effects on bone health. The prevalence of hypogonadism is approximately 20% among men with HIV, but extreme variability in the laboratory and clinical assessment of hypogonadism is reported. The prevalence of osteoporosis is 10-30%, but the poor quality of most studies does not allow definitive conclusions on clinical management. Nonetheless, the early and detailed evaluation of gonadal function and bone health is crucial for improving the quality of life of men with HIV.


Assuntos
Osso e Ossos/fisiopatologia , Infecções por HIV/epidemiologia , Hipogonadismo/diagnóstico , Osteoporose/diagnóstico , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Osso e Ossos/metabolismo , Infecções por HIV/tratamento farmacológico , Humanos , Hipogonadismo/epidemiologia , Hipogonadismo/fisiopatologia , Hipogonadismo/terapia , Masculino , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Osteoporose/terapia , Prevalência , Qualidade de Vida
3.
Clín. investig. arterioscler. (Ed. impr.) ; 32(4): 135-143, jul.-ago. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194693

RESUMO

PURPOSE: To investigate the frequency of hypogonadism and its relationship to inflammation and carotid intima-media thickness (CIMT) in male patients with predialysis chronic kidney disease (CKD). METHODS: A total of 105 patients with CKD, 55 (52.4%) as stage 3, 33 (31.4%) as stage 4 and 17 (16.2%) as stage 5, were enrolled into the study. Total testosterone (TT) and free testosterone (FT), interleukin 6 (IL-6), C-reactive protein (CRP) levels, and CIMT were measured. RESULTS: According to TT and FT, hypogonadism was detected in 18 (17.1%) and 22 (20.9%) patients, respectively. There was no difference in terms of TT and FT, CIMT, CRP and IL-6 between the stages of CKD. According to TT, the patients with hypogonadism had significantly higher CRP and high-density lipoprotein cholesterol (HDL-cholesterol) levels (p = 0.004 and p = 0.005, respectively). There was no significant difference in other parameters. According to FT, the patients with hypogonadism had significantly higher CRP (p = 0.017), and TT were negatively correlated with body mass index (BMI), waist circumference (WC), hip circumference, and CRP levels. FT was negatively correlated with age, waist circumference, systolic blood pressure, diastolic blood pressure (DBP) and CRP. CONCLUSIONS: The frequency of hypogonadism was found around 17-21% among the patients with CKD. Despite similar IL-6 and CIMT levels, CRP was found to be higher in the patients with hypogonadism. We consider that further studies with larger populations are needed to elucidate the entity


OBJETIVO: Investigar la frecuencia de hipogonadismo y su relación con la inflamación y grosor de la íntima-media carotídea (CIMT) en varones con insuficiencia renal crónica (IRC) prediálisis. MÉTODOS: Se incluyó en el estudio a un total de 105 pacientes con IRC, 55 (52,4%) en estadio 3, 33 (31,4%) en estadio 4, y 17 (16,2%) en estadio 5. Se midieron testosterona total (TT) y testosterona libre (TL), interleucina 6 (IL-6), niveles de proteína C reactiva (PCR), y CIMT. RESULTADOS: Con respecto a TT y TL, se detectó hipogonadismo en 18 (17,1%) y 22 (20,9%) pacientes, respectivamente. No se encontraron diferencias en términos de TT y TL, CIMT, PCR e IL-6 entre los diferentes estadios de IRC. Con respecto a TT, los pacientes con hipogonadismo tenían valores significativamente más altos de PCR y colesterol de lipoproteínas de alta densidad (HDL-colesterol) (p = 0,004 y p = 0,005, respectivamente). No se encontraron diferencias significativas en cuanto a otros parámetros. Con respecto a TL, los pacientes con hipogonadismo tenían valores significativamente más altos de PCR (p = 0,017), y TT guardó una correlación negativa con el índice de masa corporal (IMC), perímetro de la cintura, perímetro de la cadera, y niveles de PCR. TL se correlacionó negativamente con la edad, perímetro de cintura, presión arterial sistólica (PAS), presión arterial diastólica (PAD) y PCR. CONCLUSIONES: Se encontró frecuencia de hipogonadismo en cerca del 17-21% de los pacientes con IRC. A pesar de encontrar niveles similares de IL-6 y CIMT, los niveles de PCR fueron más altos en los pacientes con hipogonadismo. Consideramos que son necesarios más estudios, con poblaciones de mayor tamaño, para explicar esta entidad


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Hipogonadismo/epidemiologia , Inflamação/patologia , Insuficiência Renal Crônica/patologia , Aterosclerose/patologia , Testosterona/análise , Espessura Intima-Media Carotídea/instrumentação , Hipogonadismo/patologia , Testosterona/sangue , Testosterona/deficiência , Proteína C-Reativa/análise , Interleucina-6/análise , Interleucina-6/sangue , Hipogonadismo/diagnóstico , LDL-Colesterol/sangue , HDL-Colesterol/sangue
4.
Tunis Med ; 98(2): 138-143, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32395803

RESUMO

AIM: To determine the prevalence and the risk factors of hypogonadism in men with chronic renal failure (CRF). METHODS: We conducted a cross sectional analysis in 48 men with CRF. Total testosterone, prolactin, and gonadotropins were measured in all patients. Hypogonadism was defined by a low level (<10 nmol/l) or a low normal level (10-14 nmol/l) of total testosterone. RESULTS: The mean age was 53.31±10.22 years. Renal impairment was mild, moderate, severe and at end stage in 9,14,4 and 21 patients, respectively. Nineteen patients had been undergoing extra-renal purification. The average of total testosterone was 13.44±6.17 nmol/L. It was lower in patients with diabetic nephropathy (p=0.004). Hypogonadism was diagnosed in 22 patients (46 %). In this group, gonadotropins were normal in 21 cases and elevated in only one case. Hyperprolactinemia was retained in six patients. Type 2 diabetes (OR: 3.96; p=0.02) and diabetic nephropathy (OR=4.26; p=0.01) were the only risk factors of hypogonadism in our patients. CONCLUSION: Our results had demonstrated a high prevalence of hypogonadism in males with chronic renal failure. This hormone disorder was associated with type 2 diabetes and diabetic nephropathy.


Assuntos
Hipogonadismo/epidemiologia , Hipogonadismo/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Gonadotropinas/sangue , Humanos , Hipogonadismo/sangue , Hipogonadismo/diagnóstico , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , Prevalência , Prolactina/sangue , Fatores de Risco , Testosterona/sangue
5.
Internist (Berl) ; 61(6): 549-557, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32377774

RESUMO

Testosterone is a natural hormone which is essential to maintaining physical and emotional wellbeing in men, regardless of age. Male hypogonadism is an endocrine condition of testosterone deficiency with the potential to cause multiple morbidities and psychosocial problems. The condition can be of primary (testicular), secondary (hypothalamic-pituitary) or so-called functional origin (as a result of inflammatory conditions, obesity or chronic illness). Testosterone deficiency can cause symptoms of a sexual nature, foster metabolic dysfunction and impair physical abilities as well as cause osteopenia/osteoporosis and anemia. Testosterone replacement therapy should not be initiated in the case of desired paternity, unclear processes of the prostate or mammary gland and high hematocrit. Diagnosis and treatment as well as monitoring of hypogonadism treatment are clearly regulated by international guidelines and replacement therapy is proven to be effective in ameliorating the above-mentioned symptoms when performed according to these guidelines. In functional hypogonadism, which is most often, but not exclusively, found in older men, treatment of the underlying condition/co-morbidity is mandatory prior to starting testosterone substitution.


Assuntos
Androgênios/uso terapêutico , Terapia de Reposição Hormonal , Hipogonadismo/tratamento farmacológico , Osteoporose/prevenção & controle , Testosterona/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Androgênios/administração & dosagem , Disfunção Erétil/etiologia , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/etiologia , Masculino , Obesidade , Osteoporose/etiologia , Testosterona/administração & dosagem , Testosterona/efeitos adversos
6.
Eur J Endocrinol ; 183(1): 107-117, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32422605

RESUMO

Objective: Non-palpable testes remain a diagnostic challenge, often involving exploratory laparoscopy. We evaluated the diagnostic value of a wide range of reproductive hormones in order to distinguish between bilateral cryptorchidism and bilateral anorchia. Design: In this retrospective study, we identified and included 36 boys with non-palpable testes (20 with cryptorchidism, 3 with congenital hypogonadotropic hypogonadism (CHH), and 13 with anorchia) at first examination during childhood. Methods: Information on karyotype, phenotype, surgical results from laparoscopy, and biochemistry was retrieved from patient files. We compared serum concentrations of AMH, inhibin B, FSH, LH, testosterone, estradiol, and hCG stimulation testing in cryptorchid and anorchid boys to serum concentrations in a large, age-matched control group. Receiver-operating characteristic curves were used to determine the cut-off values of each reproductive hormone as a predictor of the presence of functional testicular tissue. Results: Concentrations of AMH in 0-1 year olds: ≥155 pmol/L and >1-15 year olds: ≥19 pmol/L, inhibin B (≥22 pg/mL and ≥4 pg/mL), FSH (≤28.9 IU/L and ≤20.3 IU/L) and hCG-induced testosterone (>1-15 year olds: ≥2 nmol/L) were significantly sensitive and specific markers in predicting the presence of functional testicular tissue in boys with non-palpable testes. In infancy, anorchid infants had significantly elevated gonadotropin levels, while CHH had low levels. Conclusion: Our findings suggest that laparoscopy may not be necessary in all boys with non-palpable testes if reproductive hormones unequivocally confirm the presence of functional testicular tissue. However, proving the absence may still be a diagnostic challenge.


Assuntos
Criptorquidismo/diagnóstico , Disgenesia Gonadal 46 XY/diagnóstico , Hormônios Gonadais/sangue , Hipogonadismo/diagnóstico , Testículo/anormalidades , Adolescente , Hormônio Antimülleriano/sangue , Biomarcadores/sangue , Criança , Pré-Escolar , Gonadotropina Coriônica/sangue , Diagnóstico Diferencial , Estradiol/sangue , Hormônio Foliculoestimulante/sangue , Humanos , Hipogonadismo/congênito , Lactente , Recém-Nascido , Inibinas/sangue , Hormônio Luteinizante/sangue , Masculino , Curva ROC , Estudos Retrospectivos , Testosterona/sangue
8.
Fertil Steril ; 113(1): 95-96, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32033739

RESUMO

Although chemotherapy is no complete substitute for psychotherapy in the treatment of impotence of the male patient, nevertheless, in cases where psychologic and/or somatic failure plays a role as etiologic agent then indeed chemotherapy is indicated. -T. Jakobovits.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hipogonadismo/diagnóstico , Hipogonadismo/terapia , Idade de Início , Ensaios Clínicos como Assunto/métodos , Humanos , Hipogonadismo/fisiopatologia , Masculino
10.
Rev. clín. med. fam ; 13(1): 76-80, feb. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193917

RESUMO

Los tumores de células de Leydig son raros y suponen una pequeña proporción de neoplasias testiculares (1-3 %). La forma más frecuente de presentación es una masa indolora testicular o un hallazgo ecográfico incidental acompañado en más del 80 % de los casos de desórdenes hormonales. Los marcadores tumorales séricos son negativos y aproximadamente el 30 % de los casos presentan ginecomastia. El tratamiento de elección es la cirugía (orquiectomía ingui-nal) y el seguimiento postoperatorio será prolongado. El diagnóstico definitivo es histológico y se realizará durante o tras la cirugía. Entre los marcadores inmunohistológicos de tumores de células de Leydig se incluyen alfa inhibina, calretinina y melan A. La presencia de la subunidad alfa de inhibina mediante técnica de inmunohistoquímica, destaca la intensa positividad de las células tumorales en comparación con la del tejido sano circundante. La calretinina es más sensible pero menos específica que la inhibina. Melan A es un marcador moderadamente sensible y específico en la diferenciación de tumores del estroma del cordón sexual y como tal es un valor complementario a otros marcadores inmunohistoquímicos en la valoración de tumores de difícil diagnóstico. El interés de este caso es mostrar la complejidad de alteraciones clínicas asociadas a estos tumores, así como establecer un diagnóstico diferencial con otros tumores histológicos


Leydig cell tumors are rare and account for a small proportion of testicular neoplasms (1-3%). They most frequently present as a painless testicular mass or as an incidental ultrasound finding, accompanied by hormonal disorders in more than 80% of cases. Serum tumor markers are negative and approximately 30% of cases present gynecomastia. The treatment of choice is surgery (inguinal orchiectomy) with a long post-operative follow-up. The definitive diagnosis is histological, which will be carried out during or after surgery. The immunohistochemical markers of Leydig cell tumors include inhibin alpha, calretinin, and melan-A. The presence of the inhibin alpha subunit in immunohistochemical analysis shows intense positivity of tumor cells compared with the surrounding healthy tissue. Calretinin is more sensitive but less specific than inhibin. Melan-A is a moderately sensitive and specific marker of sex cord-stromal tumors, and, as such, complements other immunohistochemical markers in the assessment of tumors which are difficult to diagnose. The interest of this case is to show the complex pattern of clinical presentation of these tumors, and to establish a differential diagnosis with other testicular tumors


Assuntos
Humanos , Masculino , Adulto Jovem , Ginecomastia/diagnóstico , Hipoadrenocorticismo Familiar/diagnóstico , Hipogonadismo/diagnóstico , Neoplasias Testiculares/patologia , Tumor de Células de Leydig/patologia , Diagnóstico Diferencial , Varicocele/diagnóstico , Seminoma/patologia
11.
Reprod Biol Endocrinol ; 18(1): 8, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996231

RESUMO

BACKGROUND: Congenital hypogonadotropic hypogonadism (CHH) is a rare disease, triggered by defective GnRH secretion, that is usually diagnosed in late adolescence or early adulthood due to the lack of spontaneous pubertal development. To date more than 30 genes have been associated with CHH pathogenesis with X-linked recessive, autosomal dominant, autosomal recessive and oligogenic modes of inheritance. Defective sense of smell is present in about 50-60% of CHH patients and called Kallmann syndrome (KS), in contrast to patients with normal sense of smell referred to as normosmic CHH. ANOS1 and FGFR1 genes are all well established in the pathogenesis of CHH and have been extensively studied in many reported cohorts. Due to rarity and heterogenicity of the condition the mutational spectrum, even in classical CHH genes, have yet to be fully characterized. METHODS: To address this issue we screened for ANOS1 and FGFR1 variants in a cohort of 47 unrelated CHH subjects using targeted panel sequencing. All potentially pathogenic variants have been validated with Sanger sequencing. RESULTS: Sequencing revealed two ANOS1 and four FGFR1 mutations in six subjects, of which five are novel and one had been previously reported in CHH. Novel variants include a single base pair deletion c.313delT in exon 3 of ANOS1, three missense variants of FGFR1 predicted to result in the single amino acid substitutions c.331C > T (p.R111C), c.1964 T > C (p.L655P) and c.2167G > A (p.E723K) and a 15 bp deletion c.374_388delTGCCCGCAGACTCCG in exon 4 of FGFR1. Based on ACMG-AMP criteria reported variants were assigned to class 5, pathogenic or class 4, likely pathogenic. Protein structural predictions, the rarity of novel variants and amino acid conservation in case of missense substitutions all provide strong evidence that these mutations are highly likely to be deleterious. CONCLUSIONS: Despite the fact that ANOS1 and FGFR1 are classical CHH genes and were thoroughly explored in several CHH cohorts we identified new, yet undescribed variants within their sequence. Our results support the genetic complexity of the disorder. The knowledge of the full genetic spectrum of CHH is increasingly important in order to be able to deliver the best personalised medical care to our patients.


Assuntos
Proteínas da Matriz Extracelular/genética , Hipogonadismo/genética , Síndrome de Kallmann/genética , Mutação/genética , Proteínas do Tecido Nervoso/genética , Receptor Tipo 1 de Fator de Crescimento de Fibroblastos/genética , Adolescente , Sequência de Aminoácidos , Feminino , Variação Genética/genética , Humanos , Hipogonadismo/diagnóstico , Síndrome de Kallmann/diagnóstico , Masculino
12.
Int J Impot Res ; 32(2): 167-175, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30670838

RESUMO

Testosterone has effects on many organs and systems. The purpose of this study was to test the hypothesis that low testosterone is associated with changes in various non-cardiovascular biomarkers in men older than 40 who were tested for possible hypogonadism. We extracted data from 9939 outpatient men who were over 40 years old (median age 56) and who also had concurrent laboratory measurements of total testosterone and one or more biomarkers of interest: estradiol, uric acid, prostate-specific antigen (PSA), sex-hormone binding globulin (SHBG), luteinizing hormone, creatinine, bone alkaline phosphatase (BAP), creatine kinase, hemoglobin A1c, and 25-hydroxy-vitamin D, and body mass index (BMI). In a smaller exploratory study of 19 otherwise healthy men presenting for evaluation of possible hypogonadism, pre-albumin (a.k.a.transthyretin, a marker of anabolism) and testosterone were measured. Men with lower levels of testosterone had significantly (p < 0.001) lower mean levels of PSA, SHBG, luteinizing hormone, and estradiol. Overall, men with low levels of testosterone also had significantly (p < 0.001) higher mean levels of LDH and BAP, but these associations varied between men who were younger or older than 56 years. There was a moderate but statistically significant positive correlation (r = 0.63, p < 0.05) between testosterone levels and pre-albumin. These results confirm our hypothesis that testosterone deficiency is associated with a broad range of systemic changes demonstrable in hormonal and non-hormonal serum assays in men over 40 years old being tested for possible hypogonadism.


Assuntos
Hipogonadismo/sangue , Testosterona/sangue , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , Estradiol/sangue , Humanos , Hipogonadismo/diagnóstico , Hormônio Luteinizante/sangue , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico/sangue
14.
Fertil Steril ; 113(1): 158-166, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31748124

RESUMO

OBJECTIVE: To analyze the prevalence of FGFR1, FGF8, and FGF17 mutations in a Chinese cohort with idiopathic hypogonadotropic hypogonadism (IHH) and to characterize the clinical presentations and therapeutic outcomes of IHH patients with FGFR1, FGF8, and FGF17 mutations. DESIGN: Retrospective cohort. SETTING: University hospital. PATIENT(S): A total of 145 IHH probands (125 men and 20 women) were recruited for this study. INTERVENTIONS(S): Hormone assays. MAIN OUTCOME MEASURE(S): Whole-exome sequencing, polymerase chain reaction-Sanger sequencing, in silico functional prediction. RESULT(S): Six novel mutations (p.154_158del, p.E496Rfs*12, p.W190X, p.S134D, p.W10X, and c.1552 + 3insT) in FGFR1, two novel mutations (p.E176K and p.R184C) in FGF8, three novel mutations (p.48_52del, p.P120L, and p.K191R) in FGF17, and five reported mutations (p.W289X, p.G237S, p.V102I, p.R250Q, and p.T340M) in FGFR1 were identified in 18 IHH patients. The functional consequences of all mutations were analyzed in silico. In addition to hypogonadotropic hypogonadism, 44.4% (8/18) patients exhibited other clinical deformities, including dental agenesis (3/18, 16.7%), hearing loss (3/18, 16.7%), and hand malformation (2/18, 11.1%). hCG/hMG therapy was effective in promoting sexual development in IHH patients with FGFR1, FGF8, and FGF17 mutations. CONCLUSION(S): We extended the mutational spectrum of FGFR1, FGF8, and FGF17 in IHH patients. The prevalence of FGFR1, FGF8, and FGF17 mutations in IHH was 12.4%. hCG/hMG therapy was effective to acquire fertility for patients with FGFR1, FGF8, and FGF17 mutations but has a risk of transmitting the mutations and IHH to the next generation.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Fator 8 de Crescimento de Fibroblasto/genética , Fatores de Crescimento de Fibroblastos/genética , Hipogonadismo/genética , Mutação/genética , Receptor Tipo 1 de Fator de Crescimento de Fibroblastos/genética , Adolescente , Adulto , Estudos de Coortes , Feminino , Genótipo , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/terapia , Masculino , Linhagem , Fenótipo , Estudos Retrospectivos , Sequenciamento Completo do Exoma/métodos , Adulto Jovem
15.
Rev. cuba. endocrinol ; 30(3): e213, sept.-dic. 2019. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126443

RESUMO

RESUMEN Introducción: El hipogonadismo masculino puede provocar una reducción importante de la calidad de vida. La determinación de testosterona total constituye la opción inicial para el diagnóstico bioquímico del hipogonadismo. Objetivo: Determinar el intervalo de referencia de testosterona total para la población masculina en edad reproductiva del municipio Plaza de la Revolución. Métodos: Se realizó un estudio transversal y descriptivo, en una muestra representativa (n= 143) de la población masculina entre 20 y 40 años de edad, del municipio Plaza de la Revolución. Para el reclutamiento de la muestra se utilizó un método directo. El intervalo de referencia se estableció mediante un método no paramétrico. Se realizó interrogatorio, examen físico, complementarios bioquímicos (glucemia, colesterol, triglicéridos, HDL-c, LDL-c), y hormonales (testosterona total, PRL, FSH y LH). Resultados: El promedio de edad fue de 29,7 años. El índice de masa corporal osciló entre 18,95 y 29,88 kg/m2 (valor medio 24,15). Las medias de las circunferencias de cintura y cadera fueron de 86,62 cm y 99,77 cm respectivamente. El intervalo de referencia de testosterona total calculado para la población masculina del municipio Plaza de la Revolución, fue de 7,69 a 40,52 nmol/L. La mediana para la testosterona total fue de 19,10 nmol/L. Conclusiones: El intervalo de referencia de testosterona total calculado para la población masculina adulta (20 - 40 años) del municipio Plaza de la Revolución difiere del reportado por el fabricante del kit diagnóstico y puede resultar de utilidad en la práctica clínica(AU)


ABSTRACT Introduction: Male hypogonadism may cause a significant reduction in the quality of life. The determination of total testosterone constitutes the initial option for the biochemical diagnosis of hypogonadism. Objective: To determine the reference interval of total testosterone for the male population in reproductive age of Plaza de la Revolución municipality. Methods: It was conducted a cross-sectional and descriptive study in a representative sample (n=143) of the male population from 20 to 40 years old of Plaza de la Revolución municipality. For the recruitment of the sample it was used a direct method. The reference interval was established through a non-parametric method. There were conducted interrogations, physical examination, complementary biochemical (blood glucose, cholesterol, triglycerides, HDL-c, LDL-c), and hormonal tests (total testosterone, PRL, FSH and LH). Results: The average age was 29.7 years. The body mass index ranged between 18.95 and 29.88 kg/m2 (mean value of 24.15). The means of the waist and hip circumferences were 86.62 and 99.77 cm, respectively. The reference interval of total testosterone calculated for the male population of Plaza de la Revolución municipality was of 7.69 to 40.52 nmol/L. The mean for total testosterone was 19.10 nmol/L. Conclusions: The reference interval of total testosterone calculated for the adult male population (20 - 40 years old) of Plaza de la Revolución municipality differs from that reported by the manufacturer of the diagnostic kit and it can be useful in clinical practice(AU)


Assuntos
Humanos , Masculino , Adulto , Exame Físico/métodos , Testosterona/efeitos adversos , Hipogonadismo/diagnóstico , Qualidade de Vida , Valores de Referência , Índice de Massa Corporal , Epidemiologia Descritiva , Estudos Transversais
16.
Arch Cardiovasc Dis ; 112(11): 699-712, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31477476

RESUMO

BACKGROUND: Long QT syndrome (LQTS) can cause the potentially fatal ventricular tachycardia torsades de pointes (TdP). QT interval corrected for heart rate (QTc) is shorter in men than in women, with testosterone contributing to shorten QTc. We recently described male hypogonadism as a reversible risk factor for acquired LQTS and TdP, but the clinical characteristics of such patients have not been characterized. AIMS: To describe the clinical characteristics of men with acquired LQTS or TdP associated with hypogonadism caused by endocrine conditions or androgen deprivation therapy (ADT), and to evaluate the relationship between testosterone concentrations and electrocardiographic changes. METHODS: We searched MEDLINE (to 04 January 2019) and the French pharmacovigilance database (to 09 August 2018) to identify male cases of acquired LQTS and TdP associated with endocrine hypogonadism or ADT; their narratives were gathered from reporting collaborators. RESULTS: We identified seven cases of TdP (one fatal) with endocrine hypogonadism, abnormally long QTc and morphologically abnormal T-wave notches. After reversion of low testosterone concentrations in the surviving patients (N=6), QTc shortened, T-wave morphology normalized and there was no TdP recurrence. Among these cases, none had mutation in the LQTS genes, three men required testosterone and three had reversible hypogonadism after resolution of a concurrent acute severe illness. We found an additional 27 reports of men with LQTS (N=6), TdP (N=9; 2/9 fatal) or sudden death (N=12; 10/12 fatal) suspected to be induced or favoured by ADT (24/27 for prostate cancer). Generally, after ADT withdrawal, QTc shortened and no TdP recurred. CONCLUSION: We propose seeking for hypogonadism caused by endocrine conditions or ADT in men presenting with TdP. Caution is warranted when ADT is used in situations at risk of TdP. Testosterone may be useful to treat or prevent TdP.


Assuntos
Antagonistas de Androgênios/efeitos adversos , Frequência Cardíaca , Hipogonadismo/induzido quimicamente , Síndrome do QT Longo/etiologia , Testosterona/deficiência , Torsades de Pointes/etiologia , Idoso , Biomarcadores/sangue , Morte Súbita Cardíaca/etiologia , Humanos , Hipogonadismo/sangue , Hipogonadismo/diagnóstico , Hipogonadismo/mortalidade , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/mortalidade , Síndrome do QT Longo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Farmacovigilância , Prognóstico , Fatores de Risco , Testosterona/sangue , Torsades de Pointes/diagnóstico , Torsades de Pointes/mortalidade , Torsades de Pointes/fisiopatologia , Adulto Jovem
17.
Best Pract Res Clin Endocrinol Metab ; 33(3): 101316, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31522908

RESUMO

Delayed puberty (DP) affects approximately 2% of adolescents. In the vast majority of patients in both sexes, it is due to constitutional delay of growth and puberty (CDGP), a self-limited condition in which puberty starts later than usual but progresses normally. However, some CDGP patients may benefit from medical intervention with low-dose sex steroids or peroral aromatase inhibitor letrozole (only for boys). Other causes of DP include permanent hypogonadotropic hypogonadism, functional hypogonadotropic hypogonadism (due to chronic diseases and conditions), and gonadal failure. In this review we discuss these themes along with the latest achievements in the field of puberty research, and include a brief synopsis on the differential diagnosis and management of patients with CDGP and congenital hypogonadotropic hypogonadism.


Assuntos
Hipogonadismo/complicações , Puberdade Tardia/terapia , Adolescente , Diagnóstico Diferencial , Feminino , Humanos , Hipogonadismo/congênito , Hipogonadismo/diagnóstico , Masculino , Puberdade/fisiologia , Puberdade Tardia/diagnóstico , Puberdade Tardia/etiologia , Puberdade Tardia/genética
18.
Sex Med Rev ; 7(4): 636-649, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31351915

RESUMO

INTRODUCTION: The International Consultation for Sexual Medicine met in Lisbon in 2018 to review updated recommendations regarding testosterone deficiency (TD) and its treatment. AIM: To provide updated clinical recommendations regarding TD and its treatment. METHODS: A Medline search was performed for testosterone (T) articles published since the 2015 International Consultation for Sexual Medicine report. Recommendations were presented at the Lisbon meeting, and feedback was incorporated into final recommendations. MAIN OUTCOME MEASURES: Selected topics for these updates included terminology, clinical diagnosis, sexual function, prostate, cardiovascular, metabolic conditions, anemia, bone health, and therapeutic options. RESULTS: The terms "testosterone deficiency" (TD) and "testosterone therapy" (TTh) were endorsed over numerous competing terms. The wide interindividual variability of sex hormone binding globulin concentrations influences the interpretation of total T concentrations. Symptoms of T deficiency more closely follow free T than total T concentrations. Symptomatic men with total T <350 ng/dL or free T <65-100 pg/mL may reasonably undergo a trial of T therapy. An empirical 6-month trial of TTh may be considered in men with strongly suggestive symptoms and values above these thresholds. Morning blood testing is indicated in men <40 years of age. Men >40 years may undergo initial afternoon testing, as long as confirmatory morning blood tests are later obtained. High-level evidence demonstrates TTh in men with TD improves sexual desire and erectile function. The weight of evidence indicates that TTh is not associated with increased risk of prostate cancer, cardiovascular events, or worsening lower urinary tract symptoms. Bone density and anemia are improved with TTh. Obesity and type 2 diabetes are associated with TD, and TTh provides consistent improvement in metabolic parameters. Multiple safe and effective therapeutic options are available to treat men with TD. CONCLUSIONS: Treatment of TD offers multiple benefits for sexual symptoms as well as for general health, without compelling evidence for increased risk of prostate cancer or cardiovascular events. Morgentaler A, Traish A, Hackett G, et al. Diagnosis and Treatment of Testosterone Deficiency: Updated Recommendations From the Lisbon 2018 International Consultation for Sexual Medicine. Sex Med Rev 2019;7:636-649.


Assuntos
Testosterona/deficiência , Anemia/etiologia , Doenças Ósseas/etiologia , Doenças Cardiovasculares/etiologia , Ensaios Clínicos como Assunto , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/tratamento farmacológico , Libido/efeitos dos fármacos , Masculino , Hiperplasia Prostática/induzido quimicamente , Neoplasias da Próstata/induzido quimicamente , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Disfunções Sexuais Fisiológicas/etiologia , Terminologia como Assunto , Testosterona/uso terapêutico
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