Wpływ testosteronowej terapii zastępczej na stężenia witaminy D i FGF-23 w hipogonadyzmie wrodzonym

Introduction: Patients with hypogonadism are at increased risk of cardiac and metabolic diseases and osteoporosis. Vitamin D and Fibroblast growth factor-23 (FGF-23) play role in the regulation of bone mineral metabolism and endothelial functions. Low vitamin D levels are reported in hypogonadism, while there is no data about the effect of testosterone replacement therapy (TRT). We investigated the effect of TRT on vitamin D and FGF-23 levels along with endothelial functions and insulin resistance in hypogonadal patients. Material and methods: Patients with congenital hypogonadotrophic hypogonadism (CHH) (n=32, age 20.6 ±1.58 years) were enrolled. TRT was implemented in transdermal form. The demographic parameters, FGF-23, 25(OH)D3, Asymmetric dimethylarginine (ADMA) and homeostatic model assessment of insulin resistance (HOMA-IR) levels were measured both before and after TRT. Results: After a follow-up period of 3.63±1.33 months, ADMA and FGF-23 levels were significantly increased (p=0.03 and p=0.005 respectively), while the 25(OH)D3 and HOMA-IR index were not significantly changed. The body mass index and waist circumference levels of the patients were also increased (p<0.001 and p=0.02) along with a significant decrease in the HDL cholesterol levels (p=0.006). Conclusions: The results show that a short term TRT increases plasma FGF-23 and ADMA levels, in young, treatment naive patients with CHH. Whether this is an early implication of TRT related adverse effects in this very young and treatment naïve population of CHH is not clear. Future prospective studies are required to find out the long-term effects of TRT on cardio-metabolic morbidity and mortality in this specific population.  Wstęp: U chorych z hipogonadyzmem występuje zwiększone ryzyko chorób sercowych I metabolicznych oraz osteoporozy. Witamina D i czynnik wzrostu fibroblastów-23 (FGF-23) uczestniczą w regulacji metabolizmu kostnego i czynności śródbłonka. Istnieją doniesienia na temat niskiego stężenia witaminy D w hipogonadyzmie, natomiast brakuje danych dotyczących wpływu testosteronowej terapii zastępczej (TRT) na to stężenie. Autorzy zbadali wpływ TRT na stężenia witaminy D i FGF-23 oraz na czynność śródbłonka i poziom insulinooporności u chorych z hipogonadyzmem. Materiał i metody: Do badania włączono chorych z wrodzonym hipogonadyzmem hipogonadotropowym (CHH) (n = 32, wiek 20,6 ± 1,58 roku). Chorzy otrzymywali TRT w postaci przezskórnej. Przez rozpoczęciem leczenia i po jego zakończeniu u chorych zebrano dane demograficzne, zmierzono stężenia FGF-23, 25(OH)D3 i asymetryczej dimetyloargininy (ADMA) oraz określono wskaźnik insulinooporności HOMA-IR. Wyniki: Po okresie obserwacji trwającym 3,63 ± 1,33 miesiąca stwierdzono istotne zwiększenie stężeń ADMA i FGF-23 (odpowiednio p = 0,03 i p = 0,005), natomiast stężenie 25(OH)D3 i wskaźnik HOMA-IR nie zmieniły się istotnie. Ponadto zaobserwowano u chorych zwiększenie wskaźnika masy ciała i obwodu pasa (p < 0,001 I p = 0,02) oraz istotne zmniejszenie stężenia cholesterol frakcji HDL (p = 0,006). Wnioski: Wyniki badania pokazują, że krótkotrwałe stosowanie TRT u młodych chorych z CHH, uprzednio nieleczonych, powoduje zwiększenie osoczowego stężenia FGF-23 i ADMA, lecz nie wpływa na stężenie witaminy D. Nie jest jasne, czy jest to wczesny efekt działań niepożądanych TRT w tej grupie bardzo młodych pacjentów z CHH. Konieczne są dalsze prospektywne badania w celu ustalenia długookresowego wpływu TRT na chorobowość i śmiertelność w związku z chorobami sercowymi i metabolicznymi w tej szczególnej populacji

Evaluation of sexual functional status and consistency of scales in patients with hypogonadotropic hypogonadism before and after testosterone replacement therapy: a single-center experience

ABSTRACT Objective: This study aimed to investigate the frequency of sexual dysfunction and the effect of short-term testosterone replacement therapy on sexual functions in congenital hypogonadism patients. Furthermore, we sought to reveal the consistency of the self-report scales used for the diagnosis of sexual dysfunction and the relationship between biochemical parameters. Materials and methods: The study was conducted on 47 young male patients aged above 18 years who were diagnosed with hypogonadotropic hypogonadism. Short (IIEF-5) and long (IIEF-15) forms of the International Index of Erectile Function and Arizona Sexual Experiences Scale (ASEX) were applied before treatment under the supervision of a physician. The patients’ blood pressure, height, and weight were measured, and their luteinizing hormone (LH), FSH, and total testosterone levels were recorded. Patients who started their treatments were called for a follow-up checkup after 6 months. Their blood pressure, height, and weight were measured by reapplying the ASEX, IIEF-5, and IIEF-15. In addition, their LH, FSH, and total testosterone levels in the biochemical tests were rerecorded. Results: In this study, the sexual dysfunction status of patients diagnosed with hypogonadotropic hypogonadism before and after treatment was evaluated using the ASEX, IIEF-15, and IIEF-5 scales. A decrease in sexual dysfunction was observed in all three scales after treatment compared with that before treatment. The IIEF-5 and IIEF-15 scales were found to be uncorrelated in terms of the pretreatment values but were correlated in terms of the post-treatment values. Although a correlation was observed between ASEX and IIEF-5 before treatment, no correlation was detected between ASEX and IIEF-15. After the treatment, ASEX was found to be correlated with both IIEF-5 and IIEF-15. The results of the scales indicated the correlation in all categories, except the pretreatment results of the IIEF-15 scale. Conclusion: The results of the current study demonstrated a significant improvement in the sexual function of hypogonadism patients undergoing short-term testosterone therapy. The ASEX, IIEF-5, and IIEF-15 scales used in the diagnosis and follow-up of sexual dysfunction were useful for evaluating sexual functions in hypogonadotropic hypogonadism patients

Triglyceride-glucose index levels in patients with congenital hypogonadotropic hypogonadism and the relationship with endothelial dysfunction and insulin resistance

Introduction: The risk of cardiometabolic diseases is increased in patients with hypogonadism. The triglyceride-glucose (TyG) index is a novel surrogate marker of insulin resistance and is associated with cardiovascular diseases. We investigated the TyG index levels and the relationship with endothelial dysfunction and insulin resistance in patients with congenital hypogonadotropic hypogonadism (CHH). Material and methods: A total of 98 patients with CHH (mean age 21.66 ± 1.99 years) and 98 healthy control subjects (mean age 21.69 ± 1.21 years) were enrolled. The demographic parameters, TyG index, asymmetric dimethylarginine (ADMA), high-sensitivity C-reactive protein (hs-CRP), and homeostatic model assessment of insulin resistance (HOMA-IR) levels were measured for all participants. Results: The patients had higher waist circumference (p < 0.001), triglycerides (p = 0.001), insulin (p = 0.003), HOMA-IR (p = 0.002), ADMA (p < 0.001), and TyG index (p < 0.001) levels and lower HDL-C (p = 0.044) and total testosterone (p < 0.001) levels compared to healthy control subjects. TyG index levels significantly correlated with the ADMA (r = 0.31, p = 0.003) and HOMA-IR (r = 0.32, p < 0.001) levels. TyG index was also determinant of HOMA-IR levels (ß = 0.20, p = 0.018). Conclusion: The results of the present study show that patients with CHH had increased TyG index levels. Also, the TyG index is independently associated with insulin resistance in patients with CHH. Long-term follow-up studies are warranted to find out the role of the TyG index in determining cardiometabolic risk in patients with hypogonadism.

Post-operative outcomes of intra-operative restrictive and conventional fluid management in laparoscopic colorectal cancer surgery

Context: Intra-operative fluid management has been shown to significantly alter a patient's clinical condition in peri-operative care. Studies in the literature that investigated the effects of different amounts of intra-operative fluids on outcomes reported conflicting results. Aims: To compare the post-operative results of intra-operative restrictive and conventional fluid administrations in laparoscopic colorectal cancer surgery. Settings and Design: All patients with ASA I, II and III, and those who had undergone laparoscopic colorectal cancer surgery were included. It was a retrospective, cohort study. Subjects and Methods: A review of laparoscopic colorectal cancer surgeries performed by the same fellow-trained colorectal surgeon with different anaesthesiologists between 1 January, 2018 and 30 November, 2021. Results: In total 80 patients were analysed; 2 patients were excluded, 28 patients were in restrictive (Group R) and 50 patients were in the conventional (Group C) group. The median age of all patients was 63 years and 74% were male. The median (interquartile ranges 25 to 75) intra-operative fluid administration was significantly different between groups; 3 ml/kg/h in Group R, and 7.2 ml/kg/h in Group C. (P < 0.001) Patients in Group C had significantly high post-operative intensive care unit admission (P < 0.05), and hospital length of stay (P = 0.005) compared to Group R. Conclusions: Intra-operative fluid management was significantly associated with post-operative hospital length of stay and intensive care unit admission. Excessive intra-operative fluid management should be avoided in daily practice to improve the outcomes of laparoscopic colorectal cancer surgery

Visceral adiposity index and triglyceride/high-density lipoprotein cholesterol ratio in hypogonadism

ABSTRACT Background Cardiometabolic risk is high in patients with hypogonadism. Visceral adiposity index (VAI) and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio are the practical markers of atherosclerosis and insulin resistance and independent predictors of cardiaovascular risk. To date, no study has evaluated VAI levels and TG/HDL-C ratio in hypogonadism. Subjects and methods A total of 112 patients with congenital hypogonadotrophic hypogonadism (CHH) (mean age, 21.7 ± 2.06 years) and 124 healthy subjects (mean age, 21.5 ± 1.27 years) were enrolled. The demographic parameters, VAI, TG/HDL-C ratio, asymmetric dimethylarginine (ADMA), high-sensitivity C-reactive protein (hs-CRP), and homeostatic model assessment of insulin resistance (HOMA-IR) levels were measured for all participants. Results The patients had higher total cholesterol (p = 0.04), waist circumference, triglycerides, insulin, and HOMA-IR levels (p = 0.001 for all) than the healthy subjects. VAI and ADMA and TG/HDL-C levels were also higher in patients than in healthy subjects (p < 0.001 for all). VAI was weakly correlated with ADMA (r = 0.27, p = 0.015), HOMA-IR (r = 0.22, p = 0.006), hs-CRP (r = 0.19, p = 0.04), and total testosterone (r = −0.21, p = 0.009) levels, whereas TG/HDL-C ratio was weakly correlated weakly with ADMA (r = 0.30, p = 0.003), HOMA-IR (r = 0.22, p = 0.006), and total testosterone (r = −0.16, p = 0.03) levels. Neither VAI nor TG/HDL-C ratio determined ADMA, HOMA-IR, and hs-CRP levels. Conclusions The results of this study demonstrate that patients with hypogonadism have elevated VAI and TG/HDL-C ratio. These values are significantly correlated with the surrogate markers of endothelial dysfunction, inflammation, and insulin resistance. However, the predictive roles of VAI and TG/HDL-C ratio are not significant. Prospective follow-up studies are warranted to clarify the role of VAI and TG/HDL-C ratio in predicting cardiometabolic risk in patients with hypogonadism

The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1-12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had >= 1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and >= 2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged <= 6 months than in the non-FGID group (P = 0.039)