Hegde Manasa, Kanathur Shilpa, Shanmukhappa Asha G, Srinivas M R
From the Department of Dermatology, Venereology and Leprosy, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Department of Radiodiagnosis, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Indian J Dermatol. 2023 Nov-Dec;68(6):723. doi: 10.4103/ijd.ijd_539_23. Epub 2024 Jan 9.
Testicular involvement in leprosy is neglected as it is insidious and silent, although it can have an impact on quality of life. Our study aimed at evaluating and estimating the frequency of the hormonal, radiological and clinical parameters in these patients.
A cross-sectional study was conducted including 31 male leprosy patients attending our OPD. After detailed clinical assessment, patients were subjected to ultrasonological with Doppler examination of the scrotum and hormonal evaluation by ELISA technique for serum follicle-stimulating hormone (FSH), luteinising hormone (LH) and total testosterone.
Thirty-one patients were included with ages ranging from 19 to 54 with a mean of 34 years. Decreased libido (19.3%) was significantly observed in the abnormal FSH ( < 0.01) and testosterone ( < 0.01) groups. The majority of the clinical findings such as erectile dysfunction, infertility and altered pubic hair pattern were seen in the lepromatous spectrum. Six (19.6%) patients had increased LH and FSH. Twenty-three (74%) had testicular atrophy (<12 ml) as assessed by USG. There was a significant association between the bilateral decreased testicular volumes (TVs) and FSH ( = 0.016 on the left and < 0.01 on the right). Four of 31 patients had altered testicular echo texture of which two belong to the BL spectrum. The increase in the resistive index (RI) corresponded significantly to the decreased TV ( < 0.01) albeit on the left side only.
A sizeable proportion (74%) of the study sample had testicular atrophy. The significant association between increased RI and testicular atrophy, especially in patients with infertility, emphasises the ancillary role of Doppler indices in methodical diagnosis. Risk factors noted in the study include increased bacillary index, delayed initiation of treatment and recurrent ENL. Early detection, early initiation of MDT and specific therapies such as testosterone replacement can help improve the quality of life.
麻风病累及睾丸的情况常被忽视，因为其隐匿且无症状，尽管它会对生活质量产生影响。我们的研究旨在评估和估算这些患者的激素、放射学及临床参数的频率。
进行了一项横断面研究，纳入了31名到我们门诊部就诊的男性麻风病患者。在进行详细的临床评估后，患者接受了阴囊超声多普勒检查，并采用酶联免疫吸附测定（ELISA）技术对血清促卵泡激素（FSH）、促黄体生成素（LH）和总睾酮进行激素评估。
纳入的31名患者年龄在19至54岁之间，平均年龄为34岁。在FSH异常（<0.01）和睾酮异常（<0.01）组中，显著观察到性欲减退（19.3%）。大多数临床症状，如勃起功能障碍、不育和阴毛形态改变，见于瘤型麻风谱。6名（19.6%）患者LH和FSH升高。经超声检查，23名（74%）患者存在睾丸萎缩（<12毫升）。双侧睾丸体积（TV）减小与FSH之间存在显著关联（左侧P = 0.016，右侧P < 0.01）。31名患者中有4名睾丸回声纹理改变，其中2名属于界线类偏瘤型谱。尽管仅在左侧，阻力指数（RI）升高与TV减小显著相关（P < 0.01）。
相当比例（74%）的研究样本存在睾丸萎缩。RI升高与睾丸萎缩之间的显著关联，尤其是在不育患者中，强调了多普勒指数在系统诊断中的辅助作用。研究中指出的危险因素包括菌指数升高、治疗开始延迟和反复发生的结节性红斑。早期检测、早期开始多药联合治疗以及特定治疗，如睾酮替代治疗，有助于改善生活质量。
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