1,721,321 research outputs found
Risk factors for androgen decline in older males: Lifestlye, chronic diseases an drugs
No full textThe aging process in men is accompanied by a progressive decline in serum testosterone levels. In addition to chronological aging, the various illnesses occurring in mid- to late-adult life and the medications used to treat them further contribute to lowering circulating testosterone levels. Any acute severe illness produces hypogonadotrophic hypogonadism; but also chronic illnesses, such as diabetes, cardiovascular disease and hypertension, lifestyle habits, such as tobacco and alcohol intake, and nutritional factors, from malnutrition to obesity, account for and accentuate the age-related decline in serum androgen levels. These issues are reviewed in a clinical perspective
Ectopic ACTH syndrome
No full textEctopic adrenocorticotropic secretion (EAS) is responsible for 12-17% of cases of Cushing's syndrome (CS) and covers a range of tumours, from undetectable benign lesions to widespread metastases. The syndrome is often associated with severe hypercortisolaemia, which aggravates the underlying condition. EAS requires a complete workup that includes the establishment of endogenous CS, diagnosis of adrenocorticotropic hormone (ACTH) dependency, localization of the source of ACTH secretion and rapid biochemical control of hypercortisolaemia. Dynamic endocrine tests should include inferior petrosal sinus sampling with CRH stimulation. Localization studies depend on the availability of reliable high-resolution cross-sectional imaging. This systematic review of the largest published series of patients with EAS (over 380 patients) reveals the common trends in the prevalence and management of this syndrome. The concept of 'occult' EAS has been revisited and the terms 'overt' and 'covert' EAS introduced. In addition to small cell lung carcinoma, the most common causes of ectopic EAS are bronchial carcinoids, thymic tumours, islet cell tumour of the pancreas, medullary thyroid carcinomas, and phaeochromocytomas. Their prevalence and the best localization modalities are presented. Medical and surgical management is discussed on the basis of the extensive experience of major referral centres
“Segmental testicular ischaemia: presentation, managment and follow-up”
Full text linkSegmental infarction of the testis is a rare event. Less than 40 cases have been reported in the literature and its aetiology remains largely unknown. The diagnosis is challenging and its identification crucial as partial ischaemia is frequently confused with testicular tumours and unnecessarily treated with orchiectomy. The objectives of this study are to: (i) raise awareness of this rare condition, (ii) provide the distinctive clinical and radiological features enabling pre-operative diagnosis, (iii) promote appropriate screening of causative factors and (iv) propose an alternative management approach to avoid surgery and preserve fertility. We describe three cases of partial testicular ischaemia in men presenting with reduced sperm quality. The cases demonstrate the ultrasound and magnetic resonance imaging appearance of testicular ischaemia. The surveillance strategy adopted for these lesions indicates that over 2 years of follow-up, marginal changes in the lesions can occur. Histology revealed that infiltration by stromal cells, leucocytes and macrophages is responsible for the remodelling of these lesions. Screening of risk factors for thromboembolism revealed that all patients carried a methylenetetrahydrofolate reductase 677C-->T (MTHFR) mutation in a gene involved in folate metabolism, and either borderline or elevated homocysteine levels. Distinctive features permit the pre-operative diagnosis of segmental testicular ischaemia. There are sufficient data to assert that a surveillance strategy is safe and feasible. We speculate that the defects in folate metabolism may pre-dispose individuals to the development of testicular infarction and infertility
Selenium and reproductive function. A systematic review
Full text linkSelenium (Se) is an essential element involved in normal gonadal development, gametogenesis, and fertilization. Molecular studies show that the gonads actively take up and store Se, most of which is incorporated in the glutathione peroxidase enzymes. We provide a systematic review of the original molecular studies, prospective observational data and randomized controlled trials on the role of Se in reproductive function conducted in the past 30 years. A critical appraisal of these findings suggests that Se supplementation produces a bell-shaped response curve, with negative effects observed for both low and high concentrations. The few available clinical trials support the use of Se supplementation (<200 μg/d) to improve male infertility, although their pre-treatment assessment of Se levels in enrolled subjects is inconsistent and their quality and size are insufficient to enable general recommendations. In females, a putative role in oocyte maturation and fertilization is suggested, but no large controlled trials have yet been performed. The role of Se supplementation on pregnancy outcomes is promising, and ongoing studies and meta-analysis should soon enable proper recommendations to be suggested. How best to assess Se in terms of cut-off value, sample type (serum, semen, other fluids) and the specific outcome of interest remains to be clarified. In the meantime, assessment of serum Se levels followed by low-dose replacement therapy when necessary is a reasonable approach to improve male idiopathic infertility and gestational outcome
Angiopoietin-1 and Angiopoietin-2 in metabolic disorders: therapeutic strategies to restore the highs and lows of angiogenesis in diabetes
No full textThe morbidity and mortality of diabetes mellitus are mostly attributed to cardiovascular complications. Despite tremendous advancement in glycemic control, anti-diabetic medications have failed to revert vascular impairment once triggered by the metabolic disorder. The angiogenic growth factors, Angiopoietin-1 (Ang1) and Angiopoietin-2 (Ang2), are crucial regulators of vessel formation and maintenance starting with embryonic development and continuing through life. In mature vessels, angiopoietins control vascular permeability, inflammation and remodeling. A crucial role of angiopoietins is to drive vascular inflammation from the active to the quiescent state, enabling restoration of tissue homeostasis. The mechanism is of particular importance for healing and repair after damage, two conditions typically impaired in metabolic disorders. There is an emerging body of evidences suggesting that the imbalance of Ang1 and Ang2 regulation, leading to an increased Ang2/Ang1 ratio, represents a culprit of the vascular alterations of patients with type-2 diabetes mellitus. Pharmacological modulation of Ang1 or Ang2 actions may help prevent or delay the onset of diabetic vascular complications by restoring vessel function, favoring tissue repair and maintaining endothelial quiescence. In this review, we present a summary of the role of Ang1 and Ang2, their involvement in diabetic complications, and novel therapeutic strategies targeting angiopoietins to ameliorate vascular health in metabolic disorders
Considerazioni SIAM su “Diagnosi, trattamento e follow-p dell’ipogonadismo maschile età-correlato: raccomandazioni di ISA, ISSAM, EAU
No full text'The limited practical value of color Doppler sonography in the differential diagnosis of men with erectile dysfunction' by Slob et al: A different point of view
No full textComment on
The limited practical value of color Doppler sonography in the differential diagnosis of men with erectile dysfunction. [Int J Impot Res. 2002
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