Michał Rabijewski

Effect of DHEA supplementation on serum IGF-1, osteocalcin, and bone mineral density in postmenopausal, glucocorticoid-treated women.

PURPOSE DHEA therapy increases bone formation in postmenopausal women. We have found only a few reports of dehydroepiandrosterone replacement therapy in women receiving long-term glucocorticoid medication. The purpose of this study was to establish whether DHEA replacement therapy may be useful in the treatment of steroid-induced osteoporosis in postmenopausal women. MATERIALS AND METHODS Nineteen women, aged 50-78 years, treated at least for three years with average daily doses of more than 7.5 mg prednisone, with T-score L2/L4<-1.5 and bisphosphonates intolerance, were enrolled to the study. For the first year of the study the patients were given calcium, vitamin D3 and thiazide diuretics. For another year the patients received orally micronized DHEA 25-50 mg daily. Before the study, after twelve months of Calcium/D3 therapy, then after six weeks and six months of DHEA therapy, serum concentrations of DHEAS, androstenedione, testosterone, estradiol, FSH, IGF-1 and osteocalcin were assessed. Bone mineral density (BMD) in lumbar spine and femoral neck was measured before the treatment, after a year on Calcium/D3 and after six and twelve months of DHEA replacement therapy. RESULTS In all treated women, DHEA significantly increased serum DHEAS, androstenedione and testosterone concentrations. A significant elevation of serum IGF-1 and osteocalcin concentrations was found as early as after six weeks of DHEA treatment. A significant increase of bone mineral density in the lumbar spine and femoral neck was observed after six and twelve months of DHEA treatment. CONCLUSION Our results suggest a beneficial role of DHEA replacement therapy in the treatment of steroid-induced osteoporosis.

The relationship between plasma androgens (dehydroepiandrosterone sulfate and testosterone) and coronary arteriosclerosis in men: The lower the androgens, the higher the coronary score of arteriosclerosis

It is known that, in postmenopausal women, estrogen deficiency is associated with disturbances in lipid metabolism and an increased risk of cardiovascular disease, while estrogen replacement therapy has beneficial effects on both these parameters. However, the role that androgens play in the development of coronary artery disease in adult men is unclear. The aim of this study was to determine whether or not there was a correlation between plasma androgens and angiogrrahically defined coronary arteriosclerosis in men. A total of 201 non-obese men aged 28–60 years (mean, 48.1 years; SE ± 5.7 years) with coronary heart disease (CHD) were included in the study.Plasma levels of dehydroepiandrosterone sulfate (DHEAS), testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), sex hormone binding globulin (SHBG), lipids and lipoproteins were determined. Arteriosclerotic lesions in the 201 patients with CHD were assessed by determining the score of coronary arterial narrowing on coronary angiogra...

Delay in Diagnosis of Adrenal Insufficiency Is a Frequent Cause of Adrenal Crisis

Delay of diagnosis of primary adrenal insufficiency (PAI) leads to adrenal crisis which is potentially lethal complication. The objective of our work was an assessment whether the establishment of diagnosis of adrenocortical insufficiency in Poland is so much delayed as assessed in the past. We have analysed data from 60 patients with diagnosis of PAI established in our department during the past 12 years and who are still under our care. We found that the time to diagnosis of primary adrenal insufficiency in Poland exceeds 3 months in every patient and 6 months in patients admitted with symptoms of adrenal crisis. Forty-four percent of patients were diagnosed only just after the hospitalisation due to crisis, despite the evident signs and symptoms of PAI. Lack of appetite and loss of body weight occurred in all patients and for that reason a diagnosis of chronic gastric and duodenal ulcer disease was the most often incorrect diagnosis. After the proper diagnosis and treatment, in the course of 1–11 years of observation, there was only 6 imminent adrenal crises in 5 patients. Our results indicated that training of primary care physicians in the field of recognising and treatment of adrenal insufficiency is still essential.

Hormonal determinants of erectile dysfunction and lower urinary tract symptoms in middle-aged and elderly men with prediabetes

Abstract Objectives: Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) are common in diabetic men. The aim of this study was to investigate hormonal determinants, the prevalence and severity of ED and LUTS in middle-aged and elderly men with prediabetes (PD). Methods: We investigated 176 men with PD and 184 healthy peers. PD was defined according American Diabetes Association. ED according IIEF scale and LUTS according IPSS scale were assessed. Total testosterone (TT), calculated free testosterone (cFT), dehydroepiandrosterone sulfate (DHEAS) and insulin-like growth factor 1 (IGF-1) were measured. Results: The prevalence of ED in patients with PD was higher than in control group (30 versus 24%) as well as the prevalence and severity of ED and LUTS in elderly (60–80 years) and middle-aged (40–59 years) men with PD was higher than in healthy peers. In middle-aged pre-diabetic men, the more severe LUTS symptoms were associated with low TT and DHEAS, while in elderly men with low cFT and DHEAS. The higher prevalence of ED in middle-aged men with PD was associated with cFT and DHEAS, while in elderly pre-diabetic men with TT and IGF-1. Conclusions: The prevalence and severity of LUTS and ED symptoms were higher in pre-diabetic men than in healthy peers. Hormonal determinants of these symptoms are different in middle-aged and elderly patients with PD.

Late-onset hypogonadism among old and middle-aged males with prediabetes in Polish population.

Abstract Objectives: Around 40% of diabetic men have lowered testosterone and symptoms of hypogonadism but the prevalence of hypogonadism among prediabetic men is unknown. The aim of this study was to investigate the prevalence of late-onset hypogonadism (LOH) in population of Polish men with prediabetes. Methods: This study was performed in 196 prediabetic men and in 184 normoglycemic, control group. Prediabetes was defined as impaired fasting glucose, impaired glucose tolerance and/or HbA1c 5.7–6.4%. LOH was defined as low libido, diminished frequency of morning erections and erectile dysfunctions in men with total testosterone <12 nmol/l. Results: Total testosterone (TT) level in prediabetes group was 11.78 ± 1.76 and 16.37 ± 1.6 nmol/l in control group (p < 0.001). LOH was diagnosed in 30% prediabetic men and in 13.6% control men. There were negative relationships between calculated free testosterone (cFT) and HbA1c (r = −0.3856; p < 0.005). In prediabetic group, TT and cFT levels were lower in patients with impaired glucose tolerance than impaired fasting glucose (p < 0.05 and p < 0.02, respectively). We showed inverse relationships between IIEF-5 score and cFT (r = −0.414, p < 0.005) and between IIEF-5 and HbA1c (r = −0.395, p < 0.002). Conclusions: In population of Polish men with prediabetes we observed high prevalence of LOH. Routine testosterone screening should be performed in all prediabetic men.

The prevalence of prediabetes in population of Polish men with late-onset hypogonadism

Abstract Objective: Prediabetes patients are likely to develop type 2 diabetes (T2DM). Low testosterone is a risk factor for impaired glucose tolerance (IGT) in men. The aim of this study was to investigate the prevalence of prediabetes in population of Polish men with late-onset hypogonadism (LOH). Methods: This study was performed in 246 men with LOH and in 184 eugonadal control group. Prediabetes was diagnosed in patients with impaired fasting glucose (IFG), IGT or with HbA1c from 5.7 to 6.4%. Sex hormones and metabolic parameters were measured. Results: The mean TT concentration in the LOH group was 9.55 ± 1.5 nmol/l and 16.45 ± 1.8 nmol/l in the control group (p < 0.001). We observed negative relationships between cFT and HbA1c (r = −0.336; p < 0.005) and between TT and HbA1c (r = −0.366, p < 0.002), In the LOH group, prediabetes was diagnosed in 41.5% men. In the control group, prediabetes was diagnosed in 13% of patients. In the LOH group, TT and cFT levels were lower in prediabetic patients, when compared with normoglycemic patients and patients with IGT had lower TT levels than subgroups with IFG or elevated HbA1c. Conclusions: In a population of Polish men with LOH, we observed high prevalence of prediabetes and routine fasting glucose and glucose tolerance test should be performed in these patients.

The Incidence of Hypogonadotropic Hypogonadism in Type 2 Diabetic Men in Polish Population

The aim of this study was to investigate the incidence of hypogonadotropic hypogonadism (HH) in type 2 diabetic men (T2DM) in population of Polish men and examine the possible influence of estradiol levels and glycemic control. We evaluated TT, cfT, estradiol, and glycemic control (HbA1c) in 184 diabetic men and in 149 nondiabetic control group. The mean HbA1c was 8.6 ± 0.2% and 6.1 ± 0.3% and cfT concentration was 0.315 ± 0.08 nmol/L and 0.382 ± 0.07 nmol/L, respectively. T2DM had higher E2 concentration than nonobese control men (29.4 ± 3.7 pg/mL versus 24.5 ± 2.9 pg/mL). Forty-six percent of T2DM were hypogonadal and 93% had HH. We observed inverse relationship between BMI and cfT (r = −0.341, P < 0.01) and positive between BMI and E2 (r = 0.329, P < 0.01). E2 concentration was higher in T2DM with HH versus T2DM with normal TT/cfT concentration (34.5 ± 5.2 versus 27.4 ± 3.4 pg/mL). We observed negative correlation between HbA1c and cfT (r = −0.336, P < 0.005) but positive between HbA1c and E2 levels (r = 0.337, P < 0.002). The prevalence of obesity, hypertension, and CVD was higher in men with hypogonadism. High incidence of hypogonadotropic hypogonadism in type 2 diabetic men in Polish population is associated with poor glycemic control and can be secondary to an increase in estradiol concentrations.

The high prevalence of testosterone deficiency in population of Polish men over 65 years with erectile dysfunctions.

Objectives: Erectile dysfunctions (EDs) are in part caused by hormonal causes; but in men over 65 years of age, testosterone deficiency seems to play an important role. However, in population of Polish men over 65 years of age with relative poor health status, the prevalence of testosterone deficiency in patients with ED is unknown. Material and methods: 286 men over 65 years of age with EDs were invited to complete an erectile function questionnaire (IIEF-5), as a diagnostic tool for EDs. Serum total testosterone (TT) levels were measured. Linear regression model was used to analyze the factors that are associated with testosterone deficiency. Results: The prevalence of testosterone deficiency was 17, 33, 42 and 57% for testosterone levels of less than 200, 250, 300 and 350 ng/dL, respectively. Only 47% patients had testosterone levels in the normal range (>350 ng/dL). The degree of ED was significantly higher in men with lowest testosterone levels (p < 0,002), and it was mild in 39.5% of cases, mild-to-moderate in 26.2%, moderate in 18.2% and severe in 16%. There was significant inverse relationship between age and TT (r = −0.3328, p < 0.05), IIEF-5 score and TT (r = −0.3149, p < 0.05) and IIEF-5 score and age (r = −0.3463, p < 0.05). The most common metabolic disorders were: obesity (68% in men with TT levels >350 ng/dL and 91% in men with TT levels <350 ng/dL) and dyslipidemia (54 and 95%, respectively). Obesity, age and hyperlipidemia all correlated with significantly decreased testosterone levels. Impaired fasting glucose did not affect the testosterone levels. Conclusions: Testosterone deficiency was very common in population of Polish men presenting with EDs and correlated negatively with age, obesity and dyslipidemia. These results can be associated with relative poor health status of Polish population.

hormonal determinants of the severity of andropausal and depressive symptoms in middle- aged and elderly men with prediabetes

Andropausal and depressive symptoms are common in aging males and may be associated with hormone deficiency. We investigated the severity of andropausal and depressive symptoms, as well as their hormonal determinants, in 196 middle-aged and elderly men (age range: 40–80 years) with prediabetes (PD) and in 184 healthy peers. PD was diagnosed according to the definition of the American Diabetes Association. The severity of andropausal and depressive symptoms was assessed using the Aging Males’ Symptoms Rating Scale and the Self-Rating Depression Scale. Total testosterone (TT), calculated free testosterone (cFT), dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor 1 (IGF-1) were measured. The prevalence of andropausal syndrome in men with PD was significantly higher than that in healthy men (35% vs 11%, respectively). In men with PD aged 40–59 years, the severity of sexual, psychological, and all andropausal symptoms was greater than in healthy peers, while in elderly men (60–80 years), only the severity of psychological symptoms was greater than in healthy peers. The severity of depressive symptoms in the middle-aged men with PD was greater than in healthy peers, while the severity of depressive symptoms in elderly men with PD and healthy peers was similar. The higher prevalence of andropausal symptoms was independently associated with cFT and IGF-1 in middle-aged men and with TT and DHEAS in elderly men with PD. The more severe depression symptoms were associated with low TT and DHEAS in middle-aged men and with low cFT and DHEAS in elderly men with PD. In conclusion, the prevalence of andropausal symptoms, especially psychological, was higher in prediabetic patients as compared to healthy men, while the severity of depressive symptoms was higher only in middle-aged men with PD. Hormonal determinants of andropausal and depressive symptoms are different in middle-aged and elderly patients, but endocrine tests are necessary in all men with PD.

Severe hypoglycaemia in elderly patients with type 2 diabetes and coexistence of cardiovascular history

BACKGROUND Hypoglycaemia is a condition that occurs when blood glucose levels fall below 3.9 mmol/L (70 mg/dL), while hypoglycaemic coma is usually associated with glycaemia around 1.1 mmol/L (20 mg/dL). Recurrent severe hypoglycaemia may result in permanent neurological disorders and also has a negative impact on the cardiovascular system. AIM To evaluate the causes of severe hypoglycaemia in elderly patients with type 2 diabetes and coexistence of cardiovascular history. METHODS We analysed retrospectively the history of 33 elderly patients with type 2 diabetes and coexistence of cardiovascular history, who were admitted to our clinic due to severe hypoglycaemia with loss of consciousness. The mean age of the patients was 76.0 ± 11.1 years, and the mean duration of diabetes was 12.0 ± 9.8 years. Glycated haemoglobin (HbA1c) was measured and the prevalence of cardiovascular diseases and therapeutic procedures were evaluated. RESULTS In the group of patients with severe hypoglycaemia, the mean value of HbA1c was 6.3 ± 1.2% (44 ± 13.1 mmol/mol), which indicates a mean glucose value below 7.8 mmol/L (140 mg/dL). Ischaemic heart disease was diagnosed in 18 patients (eight had a history of myocardial infarction), and 22 patients had arterial hypertension. Severe hypoglycaemia requiring hospitalisation in elderly patients with type 2 diabetes and coexistence of cardiovascular history was related to insulin or sulfonylurea therapy. CONCLUSIONS A low HbA1c level indicates inappropriate intensification of therapy and was associated with high risk of severe hypoglycaemic episodes in older people. The majority of severe hypoglycaemic episodes were observed in sulphonylurea or insulin-treated type 2 diabetic patients.