Mohta Alpana, Agrawal Aditi, Sharma Pritee, Singh Arti, Garg Smiley, Kushwaha Ramesh Kumar, Jain Suresh Kumar
Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India.
Department of Dermatology, Venereology and Leprology, Sawai Mansingh Medical College, Jaipur, India.
Indian Dermatol Online J. 2020 Sep 19;11(6):959-964. doi: 10.4103/idoj.IDOJ_287_20. eCollection 2020 Nov-Dec.
Leprosy or Hansen's disease poses a drastic impact on the quality of life in affected patients even after successful completion of treatment. The involvement of the endocrine system in leprosy is usually insidious, silent, and under-reported, especially the testicular dysfunction.
The present study was aimed at evaluating the abnormalities of the primary testicular hormone testosterone and the gonadotrophins LH and FSH in male patients affected with lepromatous leprosy and assessing the impact of the disease on quality of life (QOL).
The study included 43 married male patients diagnosed with lepromatous leprosy. Careful history taking and examination for symptoms of testicular dysfunction were done. Serum concentrations of total testosterone, FSH, and LH were noted. The QOL was evaluated using the WHO Quality of Life-BREF (WHOQoL-BREF).
The most common clinical manifestation of testicular dysfunction was reduced or loss of libido reported in 12 (27.9%) patients followed by gynaecomastia in 7 (16.3%). Ultrasonographic (USG) analysis revealed reduced testicular volume in 31 (72.1%) patients, and average testicular volume was 11.9 ± 4.9 mL each. Seventeen (39.5%) patients had low serum testosterone levels, 9 (20.9%) had high serum FSH level, and 11 (25.6%) high LH levels. There was a significant negative correlation between testosterone level and FSH as well as LH. There was also a significantly positive correlation between testicular volume and testosterone level. Symptomatic patients with gynaecomastia/gynaecothelia had higher hormonal derangement than those who had other symptoms. On QOL, most patients scored lowest on the domain of "social relationships" (including sexual wellbeing) followed by "psychological health".
We found a high rate of USG diagnosed testicular atrophy in lepromatous leprosy patients. Therefore, every leprosy patient should be thoroughly examined clinically to rule out features of testicular dysfunction. Testicular function tests should be routinely carried out in all leprosy patients to arrive at an early diagnosis. Leprosy is found to affect all domains of a patient's quality of life.
麻风病或汉森氏病即使在成功完成治疗后，也会对患者的生活质量产生巨大影响。麻风病累及内分泌系统的情况通常较为隐匿、不明显且报告较少，尤其是睾丸功能障碍。
本研究旨在评估瘤型麻风男性患者的主要睾丸激素睾酮以及促性腺激素促黄体生成素（LH）和促卵泡生成素（FSH）的异常情况，并评估该疾病对生活质量（QOL）的影响。
该研究纳入了43名被诊断为瘤型麻风的已婚男性患者。仔细询问病史并检查睾丸功能障碍症状。记录血清总睾酮、FSH和LH的浓度。使用世界卫生组织生活质量简表（WHOQoL - BREF）评估生活质量。
睾丸功能障碍最常见的临床表现是12名（27.9%）患者出现性欲减退或丧失，其次是7名（16.3%）患者出现乳腺增生。超声（USG）分析显示31名（72.1%）患者睾丸体积减小，平均睾丸体积为11.9±4.9毫升。17名（39.5%）患者血清睾酮水平低，9名（20.9%）患者血清FSH水平高，11名（25.6%）患者LH水平高。睾酮水平与FSH以及LH之间存在显著负相关。睾丸体积与睾酮水平之间也存在显著正相关。有乳腺增生/女乳皮病症状的患者激素紊乱程度高于有其他症状的患者。在生活质量方面，大多数患者在“社会关系”领域（包括性健康）得分最低，其次是“心理健康”。
我们发现瘤型麻风患者中超声诊断的睾丸萎缩发生率很高。因此，应对每例麻风病患者进行全面的临床检查，以排除睾丸功能障碍的特征。应在所有麻风病患者中常规进行睾丸功能检查以早期诊断。发现麻风病会影响患者生活质量的所有领域。
