ABSTRACT
El uso de opioides ha aumentado en forma significativa en las últimas décadas, lo que nos ha permitido conocer sus diversos efectos en el sistema endocrino. Estos efectos están sub diagnosticados, en parte porque los síntomas se confunden con los de la misma enfermedad que lleva al uso de opioides y porque no los buscamos de forma dirigida. El hipogonadismo y la insuficiencia suprarrenal son sus efectos más establecidos, sin embargo, otros efectos como los provocados en el tejido óseo requieren de especial atención. La evaluación de los ejes gonadotropo, adrenal y de la salud ósea debe tenerse en consideración en los usuarios crónicos de opioides, particularmente frente a la presencia de síntomas. La suspensión o reducción del uso de opioides es el primer tratamiento del compromiso endocrinológico.
The use of opioids has increased significantly in recent decades, which has allowed us to understand its effects on the endocrine system. These effects are underdiagnosed, the symptoms are confused with those of the same disease that leads to the use of opioids and we do not look for them in a targeted way. Hypogonadism and adrenal insufficiency are its most established effects, however, other effects such as the ones caused on bone tissue require special attention. Evaluation of gonadotropic and adrenal axes as well as bone health should be taken into consideration in chronic opioid users, particularly in the presence of symptoms. Stopping or reducing opioid use is the first treatment for endocrine compromise.
Subject(s)
Humans , Endocrine System Diseases/chemically induced , Endocrine System/drug effects , Analgesics, Opioid/adverse effects , Adrenal Insufficiency/chemically induced , Hypogonadism/chemically inducedABSTRACT
OBJECTIVES: To evaluate which factors influence the laboratorial diagnosis of late-onset male hypogonadism (LOH). METHODS: Total testosterone (TT), SHBG and albumin were measured in 216 men aged 52-84 years. The laboratorial definition of LOH was two values of calculated free testosterone (cFT) <6.5 ng/dl, according to Vermeulen's formula. RESULTS: At the first blood test, cFT was <6.5 ng/dl in 27 percent of the men. Laboratorial LOH (confirmed by two tests) was present in 19 percent, but TT levels were low in only 4.1 percent. Age influenced TT (p=0.0051) as well as BMI; 23.5 percent of patients > 70 years and 38.9 percent of the obese men who had TT within the reference range were, in fact, hypogonadal. CONCLUSION: Especially in obese men and in those > 70 years old, SHBG dosage is important to calculate FT levels and diagnose hypogonadism.
OBJETIVOS: Avaliar os fatores que influenciam o diagnóstico laboratorial do hipogonadismo masculino tardio. MÉTODOS: Avaliamos 216 homens entre 52 e 84 anos. O diagnóstico laboratorial foi definido como dois valores de testosterona livre calculada (TLC) <6,5 ng/dl, segundo a fórmula de Vermeulen, a partir das dosagens de testosterona total (TT), SHBG e albumina. RESULTADOS: Na primeira dosagem, a TLC foi <6.5 ng/dl em 27 por cento da amostra. Hipogonadismo laboratorial (confirmado por duas dosagens) esteve presente em 19 por cento, no entanto a TT foi baixa em apenas 4.1 por cento dos homens. A idade influenciou a TT (p=0.0051) bem como o IMC; 23,5 por cento dos homens > 70 anos e 38,9 por cento dos obesos com TT dentro dos níveis de referência eram, na verdade, hipogonádicos. CONCLUSÃO: Especialmente em homens obesos e nos > 70 anos a dosagem de SHBG é importante para calcular TL e diagnosticar o hipogonadismo.
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Middle Aged , Andropause , Albumins/analysis , Hypogonadism/diagnosis , Sex Hormone-Binding Globulin/analysis , Testosterone/blood , Age Factors , Aging , Androgens/blood , Body Mass Index , Diagnosis, Differential , Enzyme Inhibitors/adverse effects , Finasteride/adverse effects , Hypogonadism/chemically induced , Sensitivity and SpecificityABSTRACT
La hormonas esteroides, hormonas peptídicas, factores de crecimiento y otros factores tróficos, están involucrados en la regulación del crecimiento tumoral. La terapia hormonal del cáncer mamario consiste en una variedad de medidas médicas y quirúrgicas como la ooforectomía e hipofisectomía. El tratamiento de tumores hormonodependientes como el cáncer mamario, generalmente emplean antiestrógenos, pero con el advenimiento de análogos de la hormona liberadora de gonadotropinas (a-GnRH); estos neuropéptidos podrían jugar un importante papel en el tratamiento del cáncer mamario, por sus escasos efectos colaterales