Skarda S T, Burge M R
Department of Medicine, University of New Mexico School of Medicine, Albuquerque 87131, USA.
West J Med. 1998 Jul;169(1):9-12.
Exercise-induced hypogonadotropic hypogonadism is well recognized among female endurance athletes but is less commonly observed in male endurance athletes. We have reported a well-characterized case of severe acquired hypogonadotropic hypogonadism in a male distance runner with osteopenia, stress fracture, and sexual dysfunction. Using this case as an index, we hypothesized that the presence of 1 or more specific risk factors would prospectively identify male endurance athletes with exercise-induced hypogonadotropic hypogonadism. These include a history of stress fracture, sexual dysfunction, or the initiation of endurance exercise before age 18 years. We studied 28 male endurance runners younger than 50 years who ran more than 40 miles per week. Of these runners, 15 had 1 or more of the above risk factors (group 1), and the remaining 13 had none of the putative risk factors (group 2). A group of 10 sedentary control subjects was also studied (group 3). There was no difference between groups 1 and 2 in weekly training mileage. Group 1 was younger than group 2 (32 +/- 10 years versus 39 +/- 6 years, P < .05) and had a lower body mass index (22.4 +/- 1.9 kg per m2 versus 23.9 +/- 2.2 kg per m2, P < .05). By bioelectric impedance, preliminary data showed that group 1 had a reduced body fat content (group 1, 14.5% +/- 2.8%; group 2, 16.9% +/- 2.0%; and group 3, 17.5% +/- 4.1%; P < .05). Fasting morning concentrations of free testosterone (group 1, 45.3 +/- 26.4 pmol/l; group 2, 88.8 +/- 24.3 pmol/l; and group 3, 69.1 +/- 21.5 pmol/l) and luteinizing hormone (group 1, 1.7 +/- 0.7 IU per liter; group 2, 2.0 +/- 1.1 IU per liter; and group 3, 1.9 +/- 0.6 IU per liter) did not differ among the groups (P > .05). One subject with primary hypogonadism was identified in group 1. The presence of the aforementioned risk factors does not predict the occurrence of exercise-induced hypogonadotropic hypogonadism among male endurance runners in this pilot study. A larger sample size or more discriminating risk factors (or both) may be necessary to identify this uncommon but potentially debilitating condition.
运动性低促性腺激素性腺功能减退在女性耐力运动员中已得到充分认识，但在男性耐力运动员中较少见。我们报告了一例特征明确的严重获得性低促性腺激素性腺功能减退病例，该病例发生在一名患有骨质减少、应力性骨折和性功能障碍的男性长跑运动员身上。以该病例为索引，我们假设存在1种或更多特定风险因素可前瞻性地识别出患有运动性低促性腺激素性腺功能减退的男性耐力运动员。这些因素包括应力性骨折病史、性功能障碍或18岁前开始进行耐力运动。我们研究了28名年龄小于50岁、每周跑步超过40英里的男性耐力跑者。在这些跑者中，15人有1种或更多上述风险因素（第1组），其余13人没有假定的风险因素（第2组）。还研究了一组10名久坐不动的对照受试者（第3组）。第1组和第2组的每周训练里程数没有差异。第1组比第2组年轻（32±10岁对39±6岁，P<.05），且体重指数较低（22.4±1.9kg/m²对23.9±2.2kg/m²，P<.05）。通过生物电阻抗分析，初步数据显示第1组的体脂含量降低（第1组，14.5%±2.8%；第2组，16.9%±2.0%；第3组，17.5%±4.1%；P<.05）。空腹晨尿游离睾酮浓度（第1组，45.3±26.4pmol/L；第2组，88.8±24.3pmol/L；第3组，69.1±21.5pmol/L）和促黄体生成素浓度（第1组，1.7±0.7IU/L；第2组，2.0±1.1IU/L；第3组，1.9±0.6IU/L）在各组之间没有差异（P>.05）。在第1组中发现1名原发性性腺功能减退患者。在这项初步研究中，上述风险因素的存在并不能预测男性耐力跑者中运动性低促性腺激素性腺功能减退的发生。可能需要更大的样本量或更具区分性的风险因素（或两者兼具）来识别这种罕见但可能使人衰弱的疾病。
