Aarts Edo, van Wageningen Bas, Loves Sandra, Janssen Ignace, Berends Frits, Sweep Fred, de Boer Hans
Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
Clin Endocrinol (Oxf). 2014 Sep;81(3):378-86. doi: 10.1111/cen.12366. Epub 2013 Dec 12.
Obesity-related hypogonadotrophic hypogonadism (OrHH) occurs in over 40% of morbidly obese men. Obesity-related hypogonadotrophic hypogonadism may reduce the beneficial effects of bariatric surgery.
To assess the impact of OrHH on the outcome of bariatric surgery in men.
Observational study with measurement of serum gonadal hormones, and assessment of body composition, glucose, lipid and bone metabolism during the first year after bariatric surgery in 13 men with OrHH (free testosterone (free T) <225 pmol/l) and 11 age-matched eugonadal morbidly obese men (free T > 225 pmol/l).
Serum free T was inversely related to body weight (R = -0·65, P < 0·0001) and rose gradually after bariatric surgery, in eugonadal as well as in OrHH men, by 30 pmol/l for every 10 kg loss of weight. In three patients, serum free T remained within the hypogonadal range despite substantial weight loss. Gonadal hormone status prior to surgery did not affect the 1-year outcome of surgery.
Obesity-related hypogonadotrophic hypogonadism is a reversible condition in the majority of obese men. It does not reduce the efficacy of bariatric surgery. Preoperative weight-adjusted normal values are recommended to avoid an incorrect diagnosis of hypogonadism in obese men.
超过40%的病态肥胖男性会出现肥胖相关性低促性腺激素性腺功能减退（OrHH）。肥胖相关性低促性腺激素性腺功能减退可能会降低减肥手术的有益效果。
评估OrHH对男性减肥手术结局的影响。
对13名患有OrHH（游离睾酮（游离T）<225 pmol/L）的男性和11名年龄匹配的性腺功能正常的病态肥胖男性（游离T>225 pmol/L）进行观察性研究，测量血清性腺激素，并在减肥手术后第一年评估身体成分、血糖、脂质和骨代谢。
血清游离T与体重呈负相关（R = -0·65，P < 0·0001），减肥手术后，性腺功能正常的男性和患有OrHH的男性血清游离T均逐渐升高，每减重10 kg升高30 pmol/L。在三名患者中，尽管体重大幅减轻，但血清游离T仍处于性腺功能减退范围内。手术前的性腺激素状态不影响手术的1年结局。
肥胖相关性低促性腺激素性腺功能减退在大多数肥胖男性中是一种可逆性疾病。它不会降低减肥手术的疗效。建议采用术前根据体重调整的正常值，以避免对肥胖男性性腺功能减退的错误诊断。
