Erectile Dysfunction as a Cardiovascular Risk Marker

Erectile dysfunction is a common problem affecting up to 30 percent of men above 40 years old. Cardiovascular risk factors are closely associated with the development of vasculogenic erectile dysfunction. This explains the keen interest in identifying erectile dysfunction as a cardiovascular risk marker. A review of the literature reveals that erectile dysfunction has been shown to precede the development of coronary artery disease, and a number of hypotheses has been generated to support this association. Hence, it appears paramount that a complete assessment of erectile dysfunction would invariably involve assessment of cardiovascular risk factors and cardiac risk stratification. The Princeton III Consensus recommendation provides a straightforward guide for this purpose. The cardiologist should be involved early in the management of all patients with high cardiovascular risk, and some patients in the intermediate risk group.

Análisis preliminar del cuestionario Potenziani para la validación diagnóstica del hipogonadismo de comienzo tardío y su concordancia con los cuestionarios de Heinemann (AMS) y de Morley (ADAM) / Preliminary analysis of the Potenziani questionnaire for the late onset hypogonadism diagnostic validation and its concordance with the Heinemann (AMS) and Morley (ADAM) questionnaires

Hipogonadismo de comienzo tardío, es una condición que afecta 6% al 12% de hombres entre 40 y 70 años y aun así, está subdiagnosticada, por lo que se propone un cuestionario de validación diagnóstica, con el objetivo de lograr mayor sensibilidad, especifidad y predictividad que los cuestionarios ya existentes. Se analizaron 107 hombres entre 45 y 70 años, con disminución del entusiasmo en actividad diaria, cansancio fácil, menor productividad en su trabajo, cambios del humor con propensión a la irritabilidad, disminución de su masa magra muscular, con tendencia al sobrepeso y afectación en actividades recreativas y deportivas. Se hizo interrogatorio exhaustivo, examen físico y pruebas de laboratorio (perfil 20, perfil hormonal urológico masculino, antígeno prostático específico total, libre y relación libre/total, examen de orina y urocultivo). Se solicitó contestar al paciente tres cuestionarios de validación diagnóstica del hipogonadismo de comienzo tardío: Heinemann AMS (Ageing Males Survey-1999, St. Louis University, Androgen Deficiency in Aging Male), Morley ADAM-2000 y el cuestionario de validadción diagnóstica del hipogonadismo de comienzo tardío-Potenziani-2007, para ser comparados y demostrar su validez con pruebas de especificidad y sensibilidad, índice de Youden, pruebas de concordancia con intervalos de confianza del 95%, en relación al diagnóstico bioquímico del hipogonadismo de comienzo tardío. Los resultados arrojaron que el cuestionario "Potenziani" fue más sensible (88,57%), fue más específico (41,67%), tuvo el índice de validez más alto (57,01%) y el valor predictivo positivo más alto de los tres cuestionarios con el 42,5%. Por tal motivo se ha demostrado que el cuestionario propuesto es más adecuado que Heineman-AMS y el Morley-ADAM en la aproximación diagnóstica del síndrome de hipogonadismo de comienzo tardio

Late onset hypogonadism a condition which affect 6%-12% of men between 40-70 years old, and still it is subdiagnosed for which we did a validation questionnaire with the objetive to be more sensitive, especific and predictive that old questionnaires. We analized 107 men with ages between 45-70 years old whom consulted for libido deterioration, erectile dysfunction, less enthusiasm of daily life, less work-productivity, easy tiredness, humor changes with irritability, less muscle mass, overweight, and deterioration of sexual life in general. We performed exhaustive interrogatory, physical examination, and laboratoty test (20 profile, hormonal-urologic profile, prostatic specific antigen, urine and urocultive). We ask them to complete three questionnaires of late onset hypogonadism diagnostic validation: Heinemann AMS, Morley ADAM, Potenziani 2007, to be compared and show its validity with specificity and sensibility tests, Youden Index, test of concordance with confidence interval of 95%, in relation to biochemical diagnosis of deficiency testosterone syndrome. The results were that the Potenziani`s cuestionary was more sensible (88.57%), more specific (41.67%), with the validation index more high (57.01%) and with the positive predictive value more high too (42.5%). For that reason we show that Potenziani`s validation questionnaire of late onset hypogonadism, is more adecuate in the diagnostic aproximation of this condition

Testosterone replacement therapy and monitoring for the male patients with testosterone deficiency syndrome

Since the elderly population has been increasing recently in our country, old male patients with testosterone deficiency syndrome (TDS) with a significantly decreasing quality of life are becoming increasingly common. TDS in males is defined as a biochemical syndrome associated with advancing age and characterized by clinical manifestation and a deficiency in the serum testosterone level. These patients should be treated with extrinsic testosterone to improve quality of life. TDS in males should be diagnosed in the case of clinical manifestation with serum total testosterone 12 nmol/L (350 ng/dL). Products for testosterone replacement therapy (TRT) are administrated orally, transdermally, and through injectable preparations. Daily testosterone undecanoate is widely used for oral administration with good results and no hepatotoxicity. Short-acting intramuscular preparations are very effective but show wide swings in the resulting supra-physiological level of serum testosterone. Long-acting intramuscular preparations is also very effective and lasting for 3 months with normal physiologic levels. Many products for TRT on the market are effective and generally safe. However, those have a few significant adverse events each other. The ideal product should have notable effectsand few side effects, (such as selective androgen receptor modulators), be easy to administrate, maintain physiologic serum concentration, and be inexpensive. TDS in males can easily be correct by TRT. However, the advantages and disadvantages of the individual products and follow-up management of complicated adverse events should be understood before starting and maintaining TRT.