Carolyn A. Allan

Serum testosterone, dihydrotestosterone and estradiol concentrations in older men self-reporting very good health: the healthy man study

To determine serum concentrations, intra‐individual variability and impact of age‐related co‐morbidities on serum testosterone (T), dihydrotestosterone (DHT), estradiol (E2) and estrone (E1) in older men.

Androgens and obesity.

Purpose of reviewAs testosterone levels are frequently reduced in obesity, an understanding of the relationship between serum testosterone and adiposity is necessary in the clinical evaluation of these men, in particular when considering testosterone therapy. Recent findingsPopulation and interventional data suggest a bi-directional relationship exists between testosterone and obesity in men, with lower total testosterone and sex hormone binding globulin (SHBG) (and to a lesser extent free testosterone) levels than their nonobese peers; obesity having an impact at least as important as ageing. Abnormalities in the hypothalamo-pituitary-testicular axis are seen with increasing obesity. Weight loss in massive obesity increases testosterone levels but its role in mild–moderate obesity is unclear. Testosterone supplementation reduces total body fat in hypogonadal and ageing men although the effects on regional fat distribution are less well described. SummaryFavourable changes in total body fat and regional fat distribution suggest a potential role for testosterone in obesity. However, lifestyle advice to achieve sustained weight loss should be the mainstay of management. Obese men with confirmed androgen deficiency can be offered treatment, whereas in those with low-normal testosterone levels more research is needed.

Risk factors for gestational diabetes mellitus: Implications for the application of screening guidelines

Background:  Recent evidence has shown the importance of ensuring that all pregnancies with gestational diabetes mellitus (GDM) are identified and managed appropriately. However, there remains a lack of consensus as to how to best identify these women.

A new ‘total’ activin B enzyme-linked immunosorbent assay (ELISA): development and validation for human samples

Background and objective  There are currently no sensitive and specific assays for activin B that could be utilized to study human biological fluids. The aim of this project was to develop and validate a ‘total’ activin B ELISA for use with human biological fluids and establish concentrations of activin B in the circulation and fluids from the reproductive organs.

A new 'total' activin B enzyme-linked immunosorbent assay (ELISA)

Background and objective  There are currently no sensitive and specific assays for activin B that could be utilized to study human biological fluids. The aim of this project was to develop and validate a ‘total’ activin B ELISA for use with human biological fluids and establish concentrations of activin B in the circulation and fluids from the reproductive organs.

Androgen deprivation therapy complications

Androgen deprivation therapy (ADT) is increasingly used to treat advanced prostate cancer and is also utilised as adjuvant or neo-adjuvant treatment for high-risk disease. The resulting suppression of endogenous testosterone production has deleterious effects on quality of life, including hot flushes, reduced mood and cognition and diminished sexual function. Cross-sectional and longitudinal studies show that ADT has adverse bone and cardio-metabolic effects. The rate of bone loss is accelerated, increasing the risk of osteoporosis and subsequent fracture. Fat mass is increased and lean mass reduced, and adverse effects on lipid levels and insulin resistance are observed, the latter increasing the risk of developing type 2 diabetes. ADT also appears to increase the risk of incident cardiovascular events, although whether it increases cardiovascular mortality is not certain from the observational evidence published to date. Until high-quality evidence is available to guide management, it is reasonable to consider men undergoing ADT to be at a higher risk of psychosexual dysfunction, osteoporotic fracture, diabetes and cardiovascular disease, especially when treated for extended periods of time and therefore subjected to profound and prolonged hypoandrogenism. Health professionals caring for men undergoing treatment for prostate cancer should be aware of the potential risks of ADT and ensure appropriate monitoring and clinical management.

Sex Steroids and Glucose Metabolism

Testosterone levels are lower in men with metabolic syndrome and type 2 diabetes mellitus (T2DM) and also predict the onset of these adverse metabolic states. Body composition (body mass index, waist circumference) is an important mediator of this relationship. Sex hormone binding globulin is also inversely associated with insulin resistance and T2DM but the data regarding estrogen are inconsistent. Clinical models of androgen deficiency including Klinefelters syndrome and androgen deprivation therapy in the treatment of advanced prostate cancer confirm the association between androgens and glucose status. Experimental manipulation of the insulin/glucose milieu and suppression of endogenous testicular function suggests the relationship between androgens and insulin sensitivity is bidirectional. Androgen therapy in men without diabetes is not able to differentiate the effect on insulin resistance from that on fat mass, in particular visceral adiposity. Similarly, several small clinical studies have examined the efficacy of exogenous testosterone in men with T2DM, however, the role of androgens, independent of body composition, in modifying insulin resistance is uncertain.

Weight gain in pregnancy: a survey of current practices in a teaching hospital

One hundred and three obstetric and midwifery staff at a university teaching hospital were surveyed about knowledge and practices with regard to counselling women about appropriate gestational weight gain. Seventy‐seven percent of staff reported advising women about weight gain in pregnancy under some circumstances, but only 22% set specific weight or weight gain targets. Seventy‐nine percent of staff considered their training in this aspect of antenatal care to be inadequate. Further education and support of medical and nursing staff are needed to ensure guidelines for weight management in pregnancy are optimally implemented.

Endocrine Society of Australia position statement on male hypogonadism (part 1): assessment and indications for testosterone therapy

Introduction: This article, Part 1 of the Endocrine Society of Australias position statement on male hypogonadism, focuses on assessment of male hypogonadism, including the indications for testosterone therapy. (Part 2 will deal with treatment and therapeutic considerations.)

Concurrent secretion of aldosterone and cortisol from an adrenal adenoma - value of MRI in diagnosis.

A 43‐year‐old female with a 24‐years history of hypertension presented for further investigation and management of primary hyperaldosternoism. Postural studies were not conclusive and magnetic resonance (MR) imaging demonstrated a 27 × 18 mm lesion of the right adrenal gland which showed no signal loss during in and out of phase imaging. Although these appearances were considered to be atypical of those seen on MR in patients with aldosterone producing adrenal adenomas the patient underwent an adrenalectomy with removal of a 3 × 3 × 2 cm right adrenal mass. Post‐operatively she became hypotensive and a 0900 hours serum cortisol was undetectable (< 50 nmol/l), consistent with adrenal insufficiency. Following the administration of hydrocortisone there was normalization of the blood pressure and subsequent adrenal stimulation tests confirmed the presence of functioning adrenal tissue albeit with an inadequate response. Cortisol measurement from preoperative samples revealed loss of normal diurnal rhythm whereas DHEAS levels both pre and postoperatively were undetectable, consistent with ACTH supression resulting from autonomous cortisol secretion in addition to aldosterone. Concurrent secretion of cortisol should always be considered in Conns adenomas particularly when atypical radiological features are present.