Выбор метода диагностики гипогонадизма при ожирении и метаболическом синдроме у мужчин

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Андрология и генитальная хирургия. 2015; 16: 10-16

Выбор метода диагностики гипогонадизма при ожирении и метаболическом синдроме у мужчин

Кузнецова Елена Анатольевна, Адамчик А. С., Гончаров Н. П,, Кация Г. В.

https://doi.org/10.17650/2070-9781-2015-16-3-10-16

Аннотация

В настоящее время ожирение и метаболический синдром рассматриваются как симптомы мужского гипогонадизма, что подчеркивает необходимость гормонального скрининга у данной категории пациентов. Однако остаются нерешенными некоторые вопросы лабораторной диагностики дефицита андрогенов. В частности, существуют противоречия в выборе метода исследования свободного тестостерона. В задачи нашей работы входило проведение сравнительной оценки методов исследования андрогенного статуса мужчин молодого и среднего возраста, страдающих ожирением и метаболическим синдромом, и определение взаимосвязей между гормональными показателями и метаболическим профилем, артериальным давлением, антропометрическими характеристиками ожирения. Обследован 51 пациент в возрасте от 20 до 50 лет с признаками ожирения и метаболиче- ского синдрома, контрольную группу составили 19 паритетных по возрасту мужчин с нормальной массой тела. Выявлено достоверное снижение уровня общего тестостерона у мужчин с метаболическим синдромом. Найдена зависимость концентрации общего тестостерона от возраста и содержания глобулина, связывающего половые гормоны. Показана роль свободного тестостерона в формировании метаболического синдрома. Установлено, что свободный тестостерон слюны достоверно коррелирует с уровнем свободного расчетного тестостерона сыворотки. У пациентов с ожирением и метаболическим синдромом наблюдается статистически значимое увеличение показателей тестостерона слюны в сравнении со свободным расчетным тестостероном сыворотки, в то время как при нормальной массе тела различия отсутствуют. Сделан вывод, что тестостерон слюны является более чувствительным и адекватным маркером при ожирении и метаболическом синдроме.

Список литературы

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Andrology and Genital Surgery. 2015; 16: 10-16

Choice of method of diagnosis hypogonadism in obesity and metabolic syndrome in men

Kuznetsova E. A., Adamchik A. S., Goncharov N. P., Katsiya G. V.

https://doi.org/10.17650/2070-9781-2015-16-3-10-16

Abstract

Nowadays, obesity and metabolic syndrome are considered as symptoms of male hypogonadism, which underlines the need for hormonal screening in these patients. However, remain unsolved some questions of laboratory diagnostics testosterone deficiency. In particular, there are contradictions in the choice of research method of free testosterone. The objectives of our work was to conduct a comparative evaluation of methods for studying androgen status of young and middle-aged men with obesity and metabolic syndrome, and determining the relationship between hormonal indicators and metabolic profile, blood pressure, anthropometric characteristics of obesity. The study included 51 patients with symptoms of obesity and metabolic syndrome, aged from 20 to 50 years, the control group consisted of 19 equal-age men with normal body weight. A significant decrease in total testosterone in men with metabolic syndrome was revealed. The dependence of the concentration of total testosterone with age and content sex-steroid-binding globulin was found. The role of free testosterone in the formation of the metabolic syndrome was shown. It was found that free saliva testosterone significantly correlated with the level of calculated serum free testosterone. In patients with obesity and metabolic syndrome there are a statistically significant increase in saliva testosterone indicators compared to calculated serum free testosterone, while at normal body weight differences are absent. It is concluded that saliva testosterone is more sensitive and appropriate marker for obesity and metabolic syndrome.

References

1. Stanworth R.D., Jones T.H. Testosterone in obesity, metabolic syndrome and type 2 diabetes. Front Horm Res 2009;37:74–90.

2. Traish A.M., Saad F., Guay A. The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J Androl 2009;30(1):23–32.

3. Zitzmann M. Testosterone deficiency, insulin resistance and the metabolic syndrome. Nat Rev Endocrinol 2009;5(12):673–81.

4. Muraleedharan V., Jones T.H. Testosterone and the metabolic syndrome. Ther Adv Endocrinol Metab 2010;1(5):207–23.

5. Goncharov N.P., Katsya G.V., Chagina N.A., Gooren L.J. Testosterone and obesity in men under the age of 40 years. Andrologia 2009;41(2):76–83.

6. Dohle G.R., Arver S., Bettocchi C. et al. Guidelines on male hypogonadism. European Association of Urology, 2015. URL: http://uroweb.org/wp-content/uploads/18-Male-Hypogonadism_LR1.pdf.

7. Lunenfeld B., Mskhalaya G., Zitzmann M. et al. Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male 2015;18(1):5–15.

8. Dedov I.I., Kalinchenko S.Yu. Vozrastnoi androgennyi defitsit u muzhchin. M.: Prakticheskaya meditsina, 2006. 240 s. [Dedov I.I., Kalinchenko S.Yu. Age-related andropause of men. Moscow: Prakticheskaya Meditsina, 2006. 240 p. (In Russ.)].

9. Korneev I.A. Dostovernost' metodov otsenki urovnya testosterona i rezistentnost' androgenovykh retseptorov pri diagnostike vozrastnogo defitsita androgenov u muzhchin. Andrologiya i genital'naya khirurgiya 2007;(2):6–9. [Korneyeva I.A. Reliability of methods of assessment of testosterone and resistance of androgen receptor in diagnostics of age-related andropause of men. Andrologiya i genital'naya khirurgiya = Andrology and Genital Surgery 2007;(2):6–9. (In Russ.)].

10. Goncharov N.P., Katsiya G.V., Malysheva N.M. Androgennyi defitsit i problemy ego diagnostiki sovremennymi neizotopnymi metodami opredeleniya testosterona. Problemy endokrinologii 2008;54(5):30–9. [Goncharov N.P., Katsiya G.V., Malysheva N.M. Andropause and problems of its diagnostics with state-ofart non-isotope methods of determination of testosterone. Problemy endokrinologii = Endocrinology Issues 2008;54(5):30–9.(In Russ.)].

11. Goncharov N.P., Katsiya G.V., Todua T.N. i dr. Sravnitel'nyi analiz opredeleniya testosterona v syvorotke krovi razlichnymi metodami. Problemy endokrinologii 2005;51(6):31–7. [Goncharov N.P.,Katsiya G.V., Todua T.N. et al. Comparative analysis of determination of testosterone in blood serum with various methods. Problemy endokrinologii = Endocrinology Issues 2005;51(6):31–7. (In Russ.)].

12. Vermeulen A., Verdonck L., Kaufman J.M. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 1999;84(10):3666–72.

13. Goncharov N.P., Katsiya G.V., Dobracheva A.D. i dr. Svobodnyi testosteron v slyune kak diagnosticheskii marker androgennogo statusa muzhchin. Andrologiya i genital'naya khirurgiya 2006;(3):32–8. [Goncharov N.P.,Katsiya G.V., Dobracheva A.D. et al. Free testosterone in saliva as a diagnostic marker of androgene status of males. Andrologiya i genital'naya khirurgiya = Andrology and Genital Surgery 2006; (3):32–8. (In Russ.)].

16. Morley J.E., Perry H.M. 3rd, Patrick P. et al. Validation of salivary testosterone as a screening test for male hypogonadism. Aging Male 2006;9(3):165–9.

17. Arregger A.L., Contreras L.N., Tumilasci O.R. et al. Salivary testosterone: a reliable approach to the diagnosis of male hypogonadism. Clin Endocrinol 2007;67(5):656–62.

18. Cardoso E.M., Contreras L.N., Tumilasci E.G. et al. Salivary testosterone for the diagnosis of androgen deficiency in endstage renal disease. Nephrol Dial Transplant 2011;26(2):677–83.

19. Wood P. Salivary steroid assays – research or routine? Ann Clin Biochem 2009;46(3):183–96.

21. Tishova Yu.A., Mskhalaya G.Zh., Kalinchenko S.Yu. Vozrastnoi gipogonadizm u muzhchin s metabolicheskim sindromom. Sakharnyi diabet 2010;(1):22–5. [Tishova Yu.A., Mskhalaya G.Zh., Kalinchenko S.Yu. Age-related hypogonadism of men with metabolic syndrome. Sakharnyi Diabet = Diabetes Mellitus 2010;(1):22–5. (In Russ.)].

22. Daka B., Rosen T., Jansson P.A. et al. Inverse association between serum insulin and sex hormone-binding globulin in a population survey in Sweden. Endocr Connect 2013;2(1):18–22.

24. Ding E.L., Song Y., Manson J.E. et al. Sex hormone-binding globulin and risk of type 2 diabetes in women and men. New Engl J Med 2009;361(12):1152–63.

26. Laurent M.R., Vanderschueren D. Reproductive endocrinology: functional effects of sex hormone-binding globulin variants. Nat Rev Endocrinol 2014;10(9):516–7.

Выбор метода диагностики гипогонадизма при ожирении и метаболическом синдроме у мужчин

Аннотация

Choice of method of diagnosis hypogonadism in obesity and metabolic syndrome in men

Abstract

События