Hipogonadismo de inicio tardío: revisión de conceptos y pautas diagnósticas

ResumenEl hipogonadismo de inicio tardío es un síndrome clínico y bioquímico cada vez más frecuente entre la población masculina en la edad adulta, sin embargo pocas veces es diagnosticado y por lo tanto cursa sin tratamiento entre la mayoría de los varones afectados. La asociación entre deficiencia de testosterona relacionada con la edad y el diagnóstico de hipogonadismo de inicio tardío continúa siendo un tema controversial, y su asociación con síntomas como pérdida de volumen y fuerza muscular, pérdida de la libido y la función eréctil, así como cambios en el estado afectivo e intelectual del paciente resulta insidiosa ya que en ocasiones las sintomatología es atribuida al proceso «normal» de envejecimiento, o a otras comorbilidades del paciente. El diagnóstico de hipogonadismo de inicio tardío se basa en la coexistencia de bajos niveles séricos de testosterona total o libre y síntomas sugestivos de hipogonadismo. Si bien se han desarrollado cuestionarios de cribado dirigidos a pacientes con sospecha clínica, estos cuestionarios poseen sensibilidad y especificidad limitadas para el diagnóstico de hipogonadismo de inicio tardío. El diagnóstico preciso y oportuno es de crucial importancia ya que permite restablecer los niveles de testosterona y la mejoría clínica significativa mediante la terapia de remplazo hormonal.AbstractLate-onset hypogonadism is a clinical and biochemical syndrome that is increasingly more frequent in the adult male population. However, it is rarely diagnosed and therefore goes untreated in the majority of affected men. The association between age-related testosterone deficiency and late-onset hypogonadism continues to be a subject of debate and its relation to symptoms such as loss of muscle strength and volume, loss of libido, erectile dysfunction, and changes in affective and emotional statuses of the patient are insidious, given that the symptomatology is often attributed to the “normal” aging process or other comorbidities of the patient. The diagnosis of late-onset hypogonadism is based on the coexistence of low total or free testosterone serum levels and symptoms suggestive of hypogonadism. Even though screening questionnaires directed at patients with clinical suspicion of the disease have been developed for late-onset hypogonadism, their diagnostic sensitivity and specificity is limited. Accurate and opportune diagnosis is vitally important because it enables testosterone levels to be reestablished and significant clinical improvement to be made through androgen replacement therapy

Relationship between nonadiabaticity and damping in permalloy studied by current induced spin structure transformations

By direct imaging we determine spin structure changes in Permalloy wires and disks due to spin transfer torque as well as the critical current densities for different domain wall types. Periodic domain wall transformations from transverse to vortex walls and vice versa are observed, and the transformation mechanism occurs by vortex core displacement perpendicular to the wire. The results imply that the nonadiabaticity parameter β does not equal the damping α, in agreement with recent theoretical predictions. The vortex core motion perpendicular to the current is further studied in disks revealing that the displacement in opposite directions can be attributed to different polarities of the vortex core

Inflammaging as a link between autoimmunity and cardiovascular disease: The case of rheumatoid arthritis

Currently, traditional and non-traditional risk factors for cardiovascular disease have been established. The first group includes age, which constitutes one of the most important factors in the development of chronic diseases. The second group includes inflammation, the pathophysiology of which contributes to an accelerated process of vascular remodelling and atherogenesis in autoimmune diseases. Indeed, the term inflammaging has been used to refer to the inflammatory origin of ageing, explicitly due to the chronic inflammatory process associated with age (in healthy individuals). Taking this into account, it can be inferred that people with autoimmune diseases are likely to have an early acceleration of vascular ageing (vascular stiffness) as evidenced in the alteration of non-invasive cardiovascular tests such as pulse wave velocity. Thus, an association is created between autoimmunity and high morbidity and mortality rates caused by cardiovascular disease in this population group. The beneficial impact of the treatments for rheumatoid arthritis at the cardiovascular level has been reported, opening new opportunities for pharmacotherapy