Testosterone Levels in Males with Type 2 Diabetes and Their Relationship with Cardiovascular Risk Factors and Cardiovascular Disease

IntroductionOne of the factors involved in type 2 diabetes in males is a reduction in levels of testosterone, which has been shown to predict resistance to insulin and the development of cardiovascular diseases.AimTo assess the levels of testosterone in patients with type 2 diabetes and to evaluate their relationship with cardiovascular risk factors, peripheral arterial disease (PAD) and silent myocardial ischemia (SMI).MethodsTotal testosterone and sex hormone binding globulin were measured and free and bioavailable testosterones were calculated using Vermeulen's formula. Levels of total testosterone ≥12 nmol/L or free testosterone >225 pmol/L were considered normal. PAD was evaluated using the ankle-brachial index. SMI was assessed using a baseline ECG, Doppler echocardiogram, 24-hour electrocardiogram (ECG) Holter, exercise stress testing (EST), nuclear stress (if EST inconclusive), and if the result was positive, a coronary angiography.Main Outcome MeasuresPAD, SMI, testosterone, erectile dysfunction, 24-hour blood pressure Holter, body mass index (BMI), waist circumference, lipid profile, insulin resistance, chronic inflammation, United Kingdom Prospective Diabetes Study cardiovascular risk score, nephropathy, retinopathy, and neuropathy.ResultsThe study population was composed of 192 diabetic males with a mean age of 56.1 ± 7.8 years and without a history of vascular disease. Twenty-three percent presented total testosterone below normal and 21.8% presented low free testosterone. BMI, waist circumference, neuropathy, triglycerides, C-reactive protein (CRP), glucose, insulin, and HOMA-IR were found to be significantly incremented with respect to subjects with normal testosterone. There was a negative correlation of HOMA-IR with total testosterone. PAD was detected in 12% and SMI in 10.9% of subjects, and differences were not related to testosterone levels.ConclusionsWe have verified the prevalence of low testosterone levels in male patients with type 2 diabetes and have related them to variations in BMI, waist circumference, neuropathy, triglycerides, CRP, glucose, insulin and HOMA-IR, but not with an increase of SMI or PAD. Hernández-Mijares A, García-Malpartida K, Solá-Izquierdo E, Bañuls C, Rocha M, Gómez-Martínez MJ, Mármol R, and Víctor VM. Testosterone levels in males with type 2 diabetes and their relationship with cardiovascular risk factors and cardiovascular disease.     

Hypothalamo-hypophyseal-adrenal hypofunction caused by the use of bleaching cosmetics in Senegal]

Cosmetic use of bleaching agents to clear skin is widespread among black West African women. In Dakar, most products used for whole body applications contain highly potent corticosteroids. Whereas cutaneous adverse effects are well described, little is known about possible systemic consequences. In order to assess transcutaneous absorption of glucocorticoids, hypothalamo-pituitary-adrenal axis functionality can be tested. We measured plasma cortisol concentration at 8 h and 1 h after intramuscular injection of 250 micrograms of cosyntropin (Synacthen) in 12 women with a more than 10 years use of bleaching agents. Cortisol at 8 H was also measured in 9 non exposed women without disease or treatment able to disturb glucocorticoids metabolism. All controls had 8 H cortisol concentration (mean = 521 +/- 113 nmol/l) above the minimal normal level considered by our laboratory. The 8 H cortisol concentrations were under the minimal normal level in 9 exposed women and the overall mean value was significantly lower than the one observed in controls (264 +/- 81 nmol/l; p < 0.001). After cosyntropin, cortisol concentrations were elevated among all exposed women (469 +/- 196 nmol/l), and less so in 3 of them. Most of the bleaching agents users present a functional inertia of hypothalamo-pituitary adrenal axis. While there is no absolute evidence for risk of stress-induced adrenal insufficiency, our results show conclusively that an excessive corticosteroids charge among users who could be exposed to systemic adverse effects.