睾酮对无功能垂体大腺瘤和低促性腺激素性性腺功能减退患者代谢及泌尿系统结局的影响
The Testosterone Effect on Metabolic and Urologic Outcomes in Patients with Nonfunctioning Pituitary Macroadenomas and Hypogonadotropic Hypogonadism.
作者信息
Vargas-Ortega Guadalupe, Pérez-Villarreal Gabriel, Ramírez de Santiago Andrés, Balcázar-Hernández Lourdes, Mendoza-Zubieta Victoria, Landa-Gutierrez Oscar, Estrada-Robles Carlos, González-Virla Baldomero
机构信息
Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
出版信息
Int J Endocrinol. 2019 Nov 3;2019:2356580. doi: 10.1155/2019/2356580. eCollection 2019.
OBJECTIVE
To evaluate cardiovascular risk, metabolic profile, low urinary tract symptoms (LUTS), and sexual function in patients with nonfunctional pituitary macroadenoma (NFPMA) and hypogonadotropic hypogonadism with testosterone therapy (TTh).
METHODS
A retrospective clinical study at a tertiary care center was performed in 101 men with NFPMA, HH, and TTh; metabolic profile, cardiovascular risk, International Prostate Symptoms Score (IPSS), and International Index of Erectile Function 5 (IIEF-5) scores were evaluated before initiation of TTh and at the last checkup with TTh.
RESULTS
Age was 49.3 ± 8.8 years; before TTh was 195 ng/mL (101-259) vs. 574 (423-774) at the last checkup. The time of TTh administration was 34 months (12-72). An increase in triglyceride levels (200 (153-294) vs. 174 (134-233) mg/dL; =0.03), dyslipidemia (40% vs. 52%; =0.03), and MetS (25% vs. 34%; =0.05) was corroborated. A statistical difference in the Globorisk score and cardiovascular (CV) risk stratification was not found. IIEF-5 score was 15.5 ± 6.5 vs. 17.8 ± 5.3 (=0.11). An improvement in penetration quality (2.0 ± 1.5 vs. 2.6 ± 1.3; =0.05), erection after penetration (1.8 ± 1.2 vs. 2.5 ± 1.6; =0.02), completion of intercourse (1.8 ± 1.2 vs. 2.4 ± 1.3; =0.03), and satisfaction of sexual intercourse (1.8 ± 1.3 vs. 2.5 ± 1.5; =0.01) was evidenced. IPSS score was 6 (IQR 2-10) vs. 7 (IQR 4-12); =0.30. A lower rate of intermittency (14% vs. 3%; =0.02), urgency (39% vs. 16%; =0.01), and episodes of nocturia (18% vs. 4%; =0.02) was found. An increase of hematocrit (44.1 ± 4.4 vs. 47.3 ± 4.4%; =0.001), hemoglobin (14.9 ± 1.4 vs. 15.9 ± 1.4 g/dL; =0.001), and prostatic specific antigen (0.59 (0.43-1.19) vs. 0.82 (0.45-1.4) ng/mL; =0.02) was evidenced during TTh.
CONCLUSION
TTh in young men with NFPMA improves LUTS, sexual function, and some metabolic parameters, and it is relatively safe in the prostatic context.
目的
评估接受睾酮治疗（TTh）的无功能垂体大腺瘤（NFPMA）和低促性腺激素性性腺功能减退患者的心血管风险、代谢状况、下尿路症状（LUTS）和性功能。
方法
在一家三级医疗中心对101例患有NFPMA、HH并接受TTh治疗的男性患者进行了一项回顾性临床研究；在开始TTh治疗前以及最后一次TTh检查时评估代谢状况、心血管风险、国际前列腺症状评分（IPSS）和国际勃起功能指数5（IIEF-5）评分。
结果
年龄为49.3±8.8岁；TTh治疗前睾酮水平为195 ng/mL（101-259），最后一次检查时为574（423-774）。TTh治疗时间为34个月（12-72）。证实甘油三酯水平升高（200（153-294）对174（134-233）mg/dL；P=0.03）、血脂异常（40%对52%；P=0.03）和代谢综合征（25%对34%；P=0.05）。未发现Globorisk评分和心血管（CV）风险分层存在统计学差异。IIEF-5评分分别为15.5±6.5和17.8±5.3（P=0.11）。阴茎插入质量（2.0±1.5对2.6±1.3；P=0.05）、插入后勃起（1.8±1.2对2.5±1.6；P=0.02）、性交完成情况（1.8±1.2对2.4±1.3；P=0.03）和性交满意度（1.8±1.3对2.5±1.5；P=0.01）均有改善。IPSS评分分别为6（四分位间距2-10）和7（四分位间距4-12）；P=0.30。发现间歇性排尿发生率降低（14%对3%；P=0.02）、尿急发生率降低（39%对16%；P=0.01）和夜尿次数降低（18%对4%；P=0.02）。TTh治疗期间证实血细胞比容升高（44.1±4.4对47.3±4.4%；P=0.001）、血红蛋白升高（14.9±1.4对15.9±1.4 g/dL；P=0.001）和前列腺特异性抗原升高（0.59（0.43-1.19）对0.82（0.45-1.4）ng/mL；P=0.02）。
结论
年轻的NFPMA男性患者接受TTh治疗可改善LUTS、性功能和一些代谢参数，且在前列腺方面相对安全。
Zotero 插件