RESUMO
OBJECTIVE: Kallmann's syndrome (KS) is characterized by hypogonadotropic hypogonadism and olfactory disorders. The complementary exams for evaluating of patients with hypogonadotrophic hypogonadism are important for the diagnosis and management of these patients. PATIENTS: We performed a well-established olfactory Sniffin' Stick test (SST) on 17 adult patients with KS and brain magnetic resonance imaging (MRI) to evaluate olfactory structures and further analysis by Freesurfer, a software for segmentation and volumetric evaluation of brain structures. We compared the Freesurfer results with 34 healthy patients matched for age and sex and performed correlations between the data studied. RESULTS: More than half of the patients with KS reported preserved smell but had olfactory disorders in the SST. In the MRI, 16 patients showed changes in the olfactory groove, the olfactory bulb-tract complex was altered in all of them and 52% had symmetrical structural changes. Interestingly, the pituitary gland was normal in only 29%. Regarding correlations, symmetrical changes in the olfactory structures were related to anosmia in 100%, while asymmetric changes induced anosmia in only 50% (p = .0294). In Freesurfer's assessment, patients with KS, compared to controls, had lower brainstem volume. In those with aplastic anterior olfactory sulcus, the brainstem volume was lower than in hypoplasia (p = .0333). CONCLUSIONS: Olfactory assessment and MRI proved to be important auxiliary tools for the diagnosis and management of patients with KS. New studies are needed to confirm the decrease in brainstem volume found by the Freesurfer software in patients with KS. Further studies are needed to confirm the decrease in brainstem volume found by the Freesurfer software in patients with KS.
Assuntos
Hipogonadismo , Síndrome de Kallmann , Síndrome de Klinefelter , Transtornos do Olfato , Adulto , Humanos , Síndrome de Kallmann/diagnóstico , Olfato , Anosmia/patologia , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/patologia , Hipogonadismo/diagnóstico , Encéfalo/patologiaRESUMO
INTRODUCTION: Delayed puberty , usually affects psychosocial well-being. Patients and their parents show concern about genital development and stature. The condition is transient in most of the patients; nonetheless, the opportunity should not be missed to diagnose an underlying illness. AREAS COVERED: The etiologies of pubertal delay in males and their specific pharmacological therapies are discussed in this review. EXPERT OPINION: High-quality evidence addressing the best pharmacological therapy approach for each etiology of delayed puberty in males is scarce, and most of the current practice is based on small case series or unpublished experience. Male teenagers seeking attention for pubertal delay most probably benefit from medical treatment to avoid psychosocial distress. While watchful waiting is appropriate in 12- to 14-year-old boys when constitutional delay of growth and puberty (CGDP) is suspected, hormone replacement should not be delayed beyond the age of 14 years . When hypogonadism is diagnosed, hormone replacement should be proposed by the age of 12 years . Testosterone replacement has been used for decades and is fairly standardized. Aromatase inhibitors have arisen as an interesting alternative . Gonadotrophin therapy seems more physiological in patients with central hypogonadism, but its efficacy and timing still need to be established.
Assuntos
Hipogonadismo , Puberdade Tardia , Adolescente , Humanos , Masculino , Criança , Puberdade Tardia/diagnóstico , Puberdade Tardia/tratamento farmacológico , Puberdade Tardia/etiologia , Hipogonadismo/diagnóstico , Hipogonadismo/tratamento farmacológico , Hipogonadismo/complicações , Testosterona/uso terapêuticoAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hipogonadismo/diagnóstico , Disfunção Erétil/complicações , Disfunção Erétil/fisiopatologia , Testosterona/sangue , Ereção Peniana , Citrato de Sildenafila/administração & dosagem , Hipogonadismo/etiologia , Disfunção Erétil/tratamento farmacológico , Obesidade/complicaçõesRESUMO
PURPOSE: Opioids are highly addictive potent analgesics and anti-allodynics whose use has dramatically increased in recent decades. The precipitous rise in opioid dependency and opioid use disorder is an important public health challenge given the risks for severely adverse health outcomes. The long-term opioid impact on hypothalamic-pituitary axes is particularly underappreciated among both endocrinologists and primary care physicians. We review the effects of opioids on hypothalamic-pituitary-target gland function and their implications for clinical practice. METHODS: Experts in hypothalamic-pituitary disorders and opioid pharmacology reviewed recently published literature and considered strategies for diagnosing and managing these opioid-induced endocrine effects. RESULTS: Opioid suppression of hypothalamic-pituitary axes can lead to hypogonadotropic hypogonadism, central adrenal insufficiency, and hyperprolactinemia. These important clinical manifestations are often under-estimated, poorly evaluated, and typically either untreated or not optimally managed. Data on biochemical testing for diagnosis and on the effect of hormone replacement in these patients is limited and prospective randomized controlled studies for guiding clinical practice are lacking. CONCLUSIONS: Patients should be informed about risks for hypogonadism, adrenal insufficiency, and hyperprolactinemia, and encouraged to report associated symptoms. Based on currently available evidence, we recommend clinical and biochemical evaluation for potential central adrenal insufficiency, central hypogonadism, and/or hyperprolactinemia in patients chronically treated with opioids as well as the use of current expert guidelines for the diagnosis and treatment of these conditions.
Assuntos
Hiperprolactinemia , Hipogonadismo , Analgésicos Opioides/efeitos adversos , Prova Pericial , Humanos , Hipogonadismo/induzido quimicamente , Hipogonadismo/diagnóstico , Hipogonadismo/tratamento farmacológico , Estudos ProspectivosAssuntos
Hipogonadismo , Antígeno Prostático Específico , Humanos , Hipogonadismo/diagnóstico , Masculino , TestosteronaRESUMO
ABSTRACT Objective: Male hypogonadism (MH) is common among infertile men. Besides testosterone, limited MH biomarkers are available, while researchers have suggested the use of prostate-specific antigen (PSA) to help diagnose MH. Hence, we sought to evaluate the potential use of PSA to predict MH among relatively young men with infertility in Nigeria. Materials and methods: The study included 707 male partners (35-44 years) in infertile couples seeking infertility evaluation at a third-level care center in Nigeria. MH was diagnosed using standard guidelines. Receiver operating characteristic (ROC) and regression analyses explored the potential of serum free PSA (fPSA) and total PSA (tPSA) in predicting MH and MH-related clinical features. Results: In all, 29.7% of the patients had MH (MH+ve). The MH+ve group had lower mean values of fPSA and tPSA than the group without MH (MH-ve). The best fPSA threshold of < 0.25 μg/L compared with the best tPSA threshold of < 0.74 μg/L had higher accuracy (area under the curve [AUC] 0.908 versus 0.866, respectively), sensitivity (87% versus 83%, respectively), and specificity (42% versus 37%, respectively) for MH diagnosis. After adjustment for confounders, fPSA level ≤ 0.25 μg/L was more likely to predict MH-related decreased libido (odds ratio [OR] 2.728, p<0.001) and erectile dysfunction (OR 3.925, p<0.001) compared with tPSA ≤ 0.74 μg/L in the MH+ve group. Conclusion: For MH diagnosis, fPSA and tPSA had good sensitivity but very poor specificity, although fPSA had better potential for MH diagnosis and association with MH-related clinical features than tPSA. Hence, fPSA could complement other biomarkers for MH diagnosis in men 35-44 years, although we recommend further studies to confirm these findings.
Assuntos
Humanos , Masculino , Adulto , Antígeno Prostático Específico/sangue , Hipogonadismo/diagnóstico , Biomarcadores/sangue , Curva ROC , NigériaRESUMO
OBJECTIVE: Male hypogonadism (MH) is common among infertile men. Besides testosterone, limited MH biomarkers are available, while researchers have suggested the use of prostate-specific antigen (PSA) to help diagnose MH. Hence, we sought to evaluate the potential use of PSA to predict MH among relatively young men with infertility in Nigeria. METHODS: The study included 707 male partners (35-44 years) in infertile couples seeking infertility evaluation at a third-level care center in Nigeria. MH was diagnosed using standard guidelines. Receiver operating characteristic (ROC) and regression analyses explored the potential of serum free PSA (fPSA) and total PSA (tPSA) in predicting MH and MH-related clinical features. RESULTS: In all, 29.7% of the patients had MH (MH+ve). The MH+ve group had lower mean values of fPSA and tPSA than the group without MH (MH-ve). The best fPSA threshold of < 0.25 µg/L compared with the best tPSA threshold of < 0.74 µg/L had higher accuracy (area under the curve [AUC] 0.908 versus 0.866, respectively), sensitivity (87% versus 83%, respectively), and specificity (42% versus 37%, respectively) for MH diagnosis. After adjustment for confounders, fPSA level ≤ 0.25 µg/L was more likely to predict MH-related decreased libido (odds ratio [OR] 2.728, p<0.001) and erectile dysfunction (OR 3.925, p<0.001) compared with tPSA ≤ 0.74 µg/L in the MH+ve group. CONCLUSION: For MH diagnosis, fPSA and tPSA had good sensitivity but very poor specificity, although fPSA had better potential for MH diagnosis and association with MH-related clinical features than tPSA. Hence, fPSA could complement other biomarkers for MH diagnosis in men 35-44 years, although we recommend further studies to confirm these findings.
Assuntos
Hipogonadismo , Antígeno Prostático Específico/sangue , Adulto , Biomarcadores/sangue , Humanos , Hipogonadismo/diagnóstico , Masculino , Nigéria , Curva ROCRESUMO
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)