Chin Vivian L, Willliams Kristen M, Donnelley Tegan, Censani Marisa, Conroy Rushika, Lerner Shulamit, Oberfield Sharon E, McMahon Donald J, Zitsman Jeffrey, Fennoy Ilene
Department of Pediatrics, Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY, USA.
Department of Medicine, Columbia University Medical Center, New York, NY, USA.
J Pediatr Endocrinol Metab. 2018 Nov 27;31(11):1191-1197. doi: 10.1515/jpem-2018-0261.
Background Elevated body mass index (BMI) is associated with hypogonadism in men but this is not well described in adolescents. The aim is to evaluate gonadal dysfunction and the effects of weight loss after gastric banding in obese adolescent boys. Methods Thirty-seven of 54 boys (age 16.2±1.2 years, mean BMI 48.2 kg/m2) enrolled at the Center for Adolescent Bariatric Surgery at Columbia University Medical Center had low total testosterone for Tanner 5 <350 ng/dL. Sixteen had long-term hormonal data for analysis at baseline (T0), 1 year (T1) and 2 years (T2) post-surgery. T-tests, chi-squared (χ2) tests, correlation and linear mixed models were performed. Results At T0, the hypogonadal group had higher systolic blood pressure (SBP) (75th vs. 57th percentile, p=0.02), fasting insulin (19 vs. 9 μIU/mL, p=0.0008) and homeostatic index of insulin resistance (HOMA-IR) (4.2 vs. 1.9, p=0.009) compared to control group. Total testosterone was negatively correlated with fasting insulin and HOMA-IR. In the long-term analysis, BMI, weight, waist circumference (WC), and % excess weight decreased at T1 and T2 compared to T0. Mean total testosterone at T0, T1 and T2 were 268, 304 and 368 ng/dL, respectively (p=0.07). There was a statistically significant negative correlation between BMI and testosterone after 2 years (r=-0.81, p=0.003). Conclusions Low testosterone levels but unaltered gonadotropins are common in this group and associated with insulin resistance. While a significant increase in testosterone was not found over time, the negative relationship between BMI and testosterone persisted, suggesting there may be an optimal threshold for testosterone production with respect to BMI. Long-term studies are needed.
体重指数（BMI）升高与男性性腺功能减退有关，但在青少年中对此描述并不充分。目的是评估肥胖青少年男性性腺功能障碍以及胃束带术后体重减轻的影响。方法：哥伦比亚大学医学中心青少年肥胖症手术中心登记的54名男孩（年龄16.2±1.2岁，平均BMI 48.2kg/m²）中，37名坦纳5期男孩的总睾酮水平低于350ng/dL。16名男孩有基线（T0）、术后1年（T1）和2年（T2）的长期激素数据用于分析。进行了t检验、卡方（χ²）检验、相关性分析和线性混合模型分析。结果：在T0时，性腺功能减退组与对照组相比，收缩压（SBP）更高（第75百分位数对第57百分位数，p = 0.02）、空腹胰岛素水平更高（19对9μIU/mL，p = 0.0008）以及胰岛素抵抗稳态指数（HOMA-IR）更高（4.2对1.9，p = 0.009）。总睾酮与空腹胰岛素和HOMA-IR呈负相关。在长期分析中，与T0相比，T1和T2时的BMI、体重、腰围（WC）和超重百分比均下降。T0、T1和T2时的平均总睾酮分别为268、304和368ng/dL（p = 0.07）。2年后BMI与睾酮之间存在统计学显著的负相关（r = -0.81，p = 0.003）。结论：该组中睾酮水平低但促性腺激素未改变的情况常见，且与胰岛素抵抗相关。虽然未发现睾酮随时间有显著增加，但BMI与睾酮之间的负相关关系持续存在，提示可能存在与BMI相关的睾酮产生的最佳阈值。需要进行长期研究。
