Restoration of plasma testosterone levels in uremic men with clomiphene citrate.

Five men with chronic renal failure and symptoms suggestive to androgen deficiency were treated with clomiphene citrate (Clomid) at a dose of 100 mg/day for a period of 5 to 12 months. The treatment resulted uniformly in increased libido, sexual potency, and a general sense of well-being. Circulating testosterone rose from mean basal value of 223 +/- 164 to 879 +/- 171 ng/dl (SD), representing a mean increment of 290%. Mean serum lutenizing hormone (LH) and follicle-stimulating hormone (FSH) values before treatment were 76 +/- 40 and 143 +/- 85 ng/ml (SD). During treatment, both LH and FSH increased dramatically to 518 +/- 302 and 787 +/- 291 ng/ml (SD), respectively. Both serum gonadotropin values are expressed as ng/ml of LER 907. The effect of clomiphene on spermatogenesis in these subjects was inconclusive as either improvement or deterioration occured. In these five patients, serum prolactin was not related in any way to testicular function as its values were consistently in the normal range throughout the entire study period. Serum total estrogen, however, was elevated in all; the significance of this high circulating estrogen in relation to gonadal dysfunction in uremia is not clear at the present time. However, we found that normalization of circulating androgen was beneficial to our patients and that long-term clomiphene treatment achieved this goal by increasing pituitary gonadotropin secretion and secondarily stimulating testicular hormonogenesis.     

Low testosterone level is an independent determinant of endothelial dysfunction in men.

We investigated whether a low plasma testosterone level is related to endothelial dysfunction in men with coronary risk factors. One hundred and eighty-seven consecutive male outpatients (mean age+/-SD: 47+/-15 years) who underwent measurement of flow-mediated vasodilation (FMD) of the brachial artery using ultrasonography were enrolled. The relationship between plasma hormones and FMD was analyzed. Total and free testosterone and dehydroepiandrosterone-sulfate (DHEA-S) were significantly correlated with %FMD (r=0.261, 0.354 and 0.295, respectively; p<0.001), while estradiol and cortisol were not. %FMD in the highest quartile of free testosterone was 1.7-fold higher than that in the lowest quartile. Multiple regression analysis revealed that total and free testosterone were related to %FMD independent of age, body mass index, hypertension, hyperlipidemia, diabetes mellitus and smoking (beta=0.198 and 0.247, respectively; p<0.01), and were independent of age, body mass index, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, fasting plasma glucose, smoking and nitroglycerin-induced dilation (beta=0.196 and 0.227, respectively; p<0.01). DHEA-S was not significantly related to %FMD in multivariate analysis. In conclusion, a low plasma testosterone level was associated with endothelial dysfunction in men independent of other risk factors, suggesting a protective effect of endogenous testosterone on the endothelium.     

Intramuscular testosterone esters and plasma lipids in hypogonadal men: a meta-analysis

PURPOSE: It is unclear whether intramuscular administration of testosterone esters to hypogonadal men is associated with changes in plasma lipids. We therefore analyzed 19 studies published between 1987 and 1999 that focused on male subjects with nonexperimental hypogonadism, treated subjects with an intramuscular testosterone ester and reported pretreatment and post-treatment concentrations of total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol, or total triglyceride. METHODS: We calculated study-specific, post-treatment minus pretreatment differences in each plasma lipid concentration (mean [95% confidence interval]). After testing of between-study homogeneity, we combined the study-specific differences. We then determined whether heterogeneity of differences could be explained in models of the differences on study and patient characteristics (mean +/- SE) before and after excluding extreme values using a multiple outlier procedure. RESULTS: The studies represented 272 hypogonadal men (age 44 +/- 4 years; 20% with hypergonadotropic hypogonadism; total testosterone 0.5 +/- 0.2 ng/mL) who received, on average, 179 +/- 13 mg intramuscular testosterone ester every 16 +/- 1 days for 6 +/- 1 months. Fixed-effects estimates of post-treatment minus pretreatment differences were -14 [-17 to -11] mg/dL (total cholesterol), -5 [-8 to -1] mg/dL (LDL cholesterol), -4 [-5 to -2] mg/dL (HDL cholesterol), and -1 [-6 to + 4] mg/dL (triglyceride). Decreases in HDL cholesterol were larger at lower dosages of testosterone ester (r = -0.54, P = 0.055), but were not explained by attrition, regression to the mean, dosing frequency or duration, concomitant elevation of plasma total testosterone, aromatization of testosterone to estradiol, or other study and patient characteristics. CONCLUSION: Intramuscular administration of testosterone esters to hypogonadal men is associated with a small, dosage-dependent decrease in HDL cholesterol and concomitant declines in total cholesterol and LDL cholesterol. The aggregate effect of these changes on cardiovascular risk remains unknown but deserves further study.     

Low serum testosterone level as a predictor of increased visceral fat in Japanese-American men

OBJECTIVE: To examine the association between baseline testosterone levels and changes in visceral adiposity in Japanese-American men. DESIGN: Prospective observational study. SUBJECTS: Second-generation Japanese-American males enrolled in a community-based population study. MEASUREMENTS: At baseline, 110 men received a 75g oral glucose tolerance test (OGTT), and an assessment of body mass index (BMI); visceral adiposity measured as intra-abdominal fat area (IAF) using computed tomography (CT); fasting insulin and C-peptide levels; and total testosterone levels. IAF was re-measured after 7.5 y. Subcutaneous fat areas were also measured by CT in the abdomen, thorax and thigh. The total fat (TF) was calculated as the sum of IAF and total subcutaneous fat areas (SCF). RESULTS: After 7.5y, IAF increased by a mean of 8.0 cm2 (95% CI: 0.8, 15.3). Baseline total testosterone was significantly correlated with change in IAF (r= -0.26, P= 0.006), but not to any appreciable degree with change in BMI, TF, or SCF. In a linear regression model with change in IAF as the dependent variable, baseline testosterone was significantly related to this outcome while adjusting for baseline IAF, SCF, BMI, age, diabetes mellitus status (OGTT by the WHO diagnostic criteria) and fasting C-peptide (regression coefficient for baseline testosterone [nmol/l] = -107.13, P = 0.003). CONCLUSIONS: In this Japanese-American male cohort, lower baseline total testosterone independently predicts an increase in IAF. This would suggest that by predisposing to an increase in visceral adiposity, low levels of testosterone may increase the risk of type 2 diabetes mellitus.     

Percutaneous management of pancreatic abscesses: long term results in a single center

Background

Several authors consider that surgical intervention is the gold standard for treatment of pancreatic abscesses. Recently, considerable interest has been generated in the minimally invasive management of pancreatic abscess with mixed results reported in the literature.

Aim

To evaluate the efficacy of percutaneous aspiration and/or drainage for patients with pancreatic abscesses.

Methods

We performed a retrospective analysis of 62 patients with 87 pancreatic abscesses treated by percutaneous management from 1989 to 2009. All patients received appropriate antibiotic therapy. Patients with pancreatic abscess < 50 mm in diameter were initially treated by ultrasound-guided percutaneous needle aspiration (PNA) and those with abscess ≥ 50 mm were initially treated by ultrasound-guided percutaneous catheter drainage (PCD). Surgery was planned only when there was no clinical improvement after the initial percutaneous treatment. Primary outcome was conversion rate to surgery.

Results

Two patients (3.2%) received supportive treatment only and one of them died. PNA was performed in 16 patients (25.8%), and 8 of them required PCD because of recurrence of abscess. In 44 patients (70.1%), PCD was performed initially. PCD was performed twice in 6 patients and 3 times in 2 patients. There were 5 patients converted to surgery (8.1%) and one of them died. Medians (interquartile ranges) of hospital stay and catheter dwell-time were 17 (12–26) and 12 (9–21) days, respectively. There were no complications related to the procedure.

Conclusions

Percutaneous aspiration and/or drainage are effective and safe for the treatment of pancreatic abscesses.     

Interrelation between plasma testosterone and plasma insulin in healthy adult men: the Telecom Study

Summary Plasma insulin is a risk factor for diabetes mellitus and cardiovascular disease in men. We investigated the association between plasma testosterone and plasma insulin in an occupational sample of 1292 healthy adult men. Total plasma testosterone decreased with each decade of age and insulin increased with each decade of age. In these cross-sectional data, this significant graded inverse association between testosterone and insulin was independent of age. The association was reduced but not explained by the addition of obesity and subscapular skinfold to the model. Adjustment for alcohol consumption, cigarette smoking and plasma glucose did not materially alter the association. These results are the reverse of the positive association of androgens with insulin in women and suggest alternative possible explanations for the effect of hyperinsulinaemia on cardiovascular disease risk. Prospective studies will be necessary to determine the direction and causal nature of this association.     

Parallel nocturnal secretion of melatonin and testosterone in the plasma of normal men

Abstract: Differences and similarities in the temporal organization of hormone secretion in plasma reflect the activity of CNS pacemakers. One aspect of this activity, the temporal synchronization of the secretion of different hormones is still poorly understood. We report the analysis of melatonin and testosterone plasma concentrations during two nights in 6 normal healthy young men. Blood was collected every 20 min between 2040 and 0640. Plasma testosterone concentrations increased by 1.5- to 2-fold during the second part of the night, and melatonin by 2.5- to 4-fold. In each subject, the individual temporal pattern of melatonin was quite stable over the two nights of sampling, while testosterone profiles showed fluctuations. There was a high degree of parallelism in these two hormones nocturnal secretion. These results, together with previous studies, suggest that melatonin might entrain the nocturnal secretion of testosterone.     

Systolic dysfunction is a predictor of long term mortality in men but not in women with heart failure.

AIMS: To evaluate possible gender differences in clinical profile and outcome of patients hospitalised with heart failure. METHODS AND RESULTS: During 1996 a total of 1065 hospital in-patients had confirmed heart failure, with follow-up data through 2002. Women (58%) were significantly older, had higher prevalence of hypertension and diabetes, and lower prevalence of ischaemic heart disease, chronic pulmonary disease and alcoholism. The proportion of patients with normal left ventricular ejection fraction (LVEF) increased with age, but in all age groups women had normal LVEF more frequently than men. Echocardiography was performed less frequently in females: 62% vs. 71% in men, P<0.01, and this finding was consistent in all age groups. During follow-up (median 19 months) 507 patients died (216 men [48.8%] and 291 women [46.8%]). Gender was not a predictor of survival when LVEF was included in the model (RH Male Gender 0.8, 95% CI 0.6 to 1.1, P=0.2). There was a significant interaction gender-LVEF (P=0.048): survival was similar in both genders with LVEF >0.3 but women with LVEF 0.3 while men with severely depressed LVEF have a worse prognosis.     

Dissociated responses of plasma testosterone and estradiol to human chorionic gonadotropin in adult men.

Plasma testosterone (T), dihydrotestosterone (DHT) and estradiol (E2) were determined by radioimmunoassay in 10 normal males receiving hCG im 5000 IU on days 1, 2 and 3. The mean increase of plasma steroid on days 2, 3 and 1, respectively, was: 1.42, 1.79 and 1.87 times for T; 1.17, 1.56 and 1.49 times for DHT; 4.04, 3.29 and 2.33 times for E2. While T was still significantly increasing from day 2 to day 4, E2 significantly decreased. A positive correlation (P less than 0.01) was found between the basal T and the E2 peak after hCG, suggesting a release of E2 from a storage compartment in the testis. No significant change of either steroid was detected 4 h after the first hCG injection. In 6 cases of primary male hypogonadism, the mean basal values of T to hCG was defective, despite considerable individual variations. In 14 males with gonadotropin deficiency, basal values of T and E2 were very low; the T response to hCG ranged from undetectable to dramatic, and was correlated with the degree and duration of previous exposure to gonadotropin; and impaired response of E2 in all cases porvides a better estimate of the actual gonadotropin deficiency.     

Steroid-binding proteins and testosterone level in the badger plasma during the annual cycle

Steroid-protein interactions were studied in the male badger Meles meles L. during a seasonal sexual cycle. Specific steroid-binding plasma proteins were determined by equilibrium dialysis. This study demonstrates the existence of two high-affinity steroid-binding proteins: one which has high affinity for corticosterone and saturable binding sites and resembles a transcortin-type protein, and the other which has a high affinity and limited capacity for binding DHT and could be a protein of the sex-hormone-binding protein type. The plasma concentrations of these two binding proteins fluctuate throughout the year. Transcortin concentration is not significantly higher in winter and spring than in summer and autumn. The SBP binding capacity is difficult to correlate with testosterone concentrations.     

Effects of long term sulfonylurea therapy on plasma insulin and fasting lipid levels.

Insulin secretion was studied before and after the control of hyperglycemia in fourteen maturity onset male non-obese diabetics. Optimum control of hyperglycemia was achieved by the addition of the sulfonylurea chlorpropamide to dietary treatment. One patient was a primary treatment failure, but nine out of thirteen had excellent control of hyperglycemia. A standardized oral glucose tolerance test (GTT) was performed before and after eight months of individualized therapy with the sulfonylurea. The GTT was repeated with each patient taking his usual dose of chlorpropamide 90 min prior to the administrationo f the glucose load. In the baseline test glucose levels rose from 135.6 +/- 9.9 mg/dl to a peak level of 268.8 +/- 17.7 mg/dl at 120 min. After control of hyperglycemia glucose levels were significantly lower at 0, 30 and 60 min, and rose from 106.8 +/- 8.5 mg/dl to a maximum of 224.5 +/- 17.3 mg/dl at 120 min. Plasma insulin response was unchanged. Fasting serum cholesterol, triglyceride and total lipid levels changed only minimally during therapy. It is concluded that lowered serum glucose levels after long term treatment with chlorpropamide occured while plasma insulin response to glucose was no greater than before treatment. These findings may be explained by an extrapancreatic effect of the drug or by an indirect result of chlorpropamide induced insulin release which occured earlier in the course of therapy.     

老年男性急性冠脉综合征患者游离睾酮水平与妊娠相关蛋白A及细胞间黏附因子1的关系

目的 观察老年男性急性冠脉综合征( ACS)患者体内游离睪酮水平(FT)与炎症因子妊娠相关蛋白A(PAPP-A)、细胞间黏附因子-1 (ICAM-1)的相关性.方法 采用酶联免疫法检测88例老年男性体内FT与 PAPP-A、ICAM-1,其中ACS患者46例,同年龄健康对照42例.采用多因素逐步回 归方法分析FT与 PAPP-A、ICAM-1的相关性.结果 老年男性ACS患者体内FT低于对照组(P＜0.01),而PAPP-A、ICAM-1分别高于对照组(P＜0.01),FT水平与 PAPP-A、ICAM-1负相关.结论 老年男性ACS患者体内FT与炎症因子PAPP-A、ICAM-1负相关.     

Pretreatment serum level of testosterone as a prognostic factor in Japanese men with hormonally treated stage D2 prostate cancer.

Pretreatment serum level of testosterone (T) is a potential prognostic factor for prostate cancer. However, T levels in Japanese prostate cancer patients are unknown to date. To evaluate the clinical significance of pretreatment serum T level in such patients, serum T level was analyzed in relation to several clinical factors in a total of 130 patients with various stages of prostate cancer, 74 of whom had metastatic disease (stage D2) and received endocrine therapy as first-line treatment. The mean pretreatment T level in patients with non-metastatic prostate cancer (stages B + C) was significantly lower than that in stage D2 patients (B + C: 4.05 +/- 2.01 ng/ml; D2: 4.85 +/- 2.18 ng/ml, p = 0.0344). On the other hand, the mean serum level of T was higher in stage D2 patients who showed good response to endocrine therapy (CR: 5.42 +/- 1.55 ng/ml; non-CR: 4.30 +/- 2.63 ng/ml, p = 0.0320). When the 74 stage D2 patients were divided into high and low T level groups according to the median value, those patients with a high T level had significantly better cause-specific and progression-free survival. Multivariate analysis demonstrated that extent of bone metastases (EOD) grade, pretreatment serum T level and tumor marker response to endocrine therapy were significant predictors for progression-free survival. In conclusion, a higher pretreatment T level appears to be predictive of the marker response to endocrine therapy, showing positive prognostic value and indicating good prognosis in patients at the metastatic stage. However, a higher T level was also associated with stage progression of this disease.     

Effects of prolactin and prolactin plus luteinizing hormone on plasma testosterone levels in normal adult men.

In an earlier study, normal adult men were shown to have increased plasma testosterone (T) levels over a several-hour period after haloperidol-induced increases in plasma PRL levels. The present study was designed both to replicate our first study and to examine the potential synergism of PRL and LH in influencing T levels on a short term basis in normal men. Eight volunteers received on 4 separate days an in injection of saline or 0.5 mg haloperidol at 1000 h and an iv injection of saline or 88 IU human LH (hLH) at 1100 h in a double blind randomized block design arranged to augment plasma levels of PRL, LH, and PRL and LH together on the different test days as well as to afford a saline control day. Only five of the eight subjects had prompt PRL responses to haloperidol equivalent to those of our earlier study. As the purpose of this study was to examine the effect of increased PRL on plasma T levels, these five subjects were used for the determination of changes in plasma T. After haloperidol administration, their PRL levels rose an average of 19 ng/ml, to the high-normal range, and after the hLH infusions, their LH levels rose an average of 71 ng/ml. On the saline control day, mean T levels showed the normal diurnal decline. After 0.5 mg haloperidol, T levels were maintained for several hours, and after 88 IU hLH, T levels were increased for several hours. Increased PRL levels concomitant with hLH administration did not produce a T response greater than that caused by hLH alone. The results of this study replicate the effect of drug-induced PRL augmentation on plasma T levels found in our earlier study, but they fail to demonstrate a synergistic effect of acutely increased PRL on LH-stimulated T secretion. PRL thus seems to be another pituitary hormone capable of increasing plasma T in adult men, but it clearly is a weaker stimulus than LH.