ABSTRACT
Women in their fourth decade and older experience a decrease in androgen serum levels. This may lead to the clinical syndrome of female androgen insufficiency expressed by insidious tiredness, diminished sense of well-being and libido, alterations in body composition and bone loss. If there is a past history of bilateral oophorectomy, hypopituitarism, androgen adrenal suppression and/or free testosterone serum levels are low, it is probable that these signs and symptoms could be relieved by a discerning androgen administration, which has been largely accepted. When current recommended doses are used, it appears that the benefits regarding bone mass, sexuality and well-being may be achieved without important signs of masculinizing. Nonetheless, it is necessary to conduct well-controlled, long-term studies, in order to validate the hypothesis that therapeutic administration of androgens to women does not lead to an increased incidence of breast cancer or metabolic complications.
Subject(s)
Androgens/deficiency , Androgens/therapeutic use , Hormone Replacement Therapy , Menopause/physiology , Androgens/adverse effects , Body Composition/drug effects , Bone Density/drug effects , Breast Neoplasms/chemically induced , Cardiovascular Diseases/chemically induced , Female , Gonadal Steroid Hormones/metabolism , Hormone Replacement Therapy/adverse effects , Humans , Sexual Behavior/drug effects , Testosterone/bloodABSTRACT
BACKGROUND: Early recognition of heart disease in diabetics is a highly desirable goal, and diastolic dysfunction, one of its earliest manifestations, can be readily assessed by tissue Doppler imaging. We tested in normotensive diabetics without signs of coronary artery disease whether tissue Doppler imaging would improve the diagnosis of diastolic dysfunction beyond classical criteria and identify patients already presenting impaired cardiac performance. METHODS: We studied 79 patients (56 males, 55 type-2 diabetes mellitus) who underwent Doppler echocardiography, and exercise testing. Diastolic dysfunction was diagnosed either based on European Study Group on Diastolic Heart Failure guidelines or by tissue Doppler imaging provided that both of the following criteria were met: Em/Am ratio <1; and Em < 8.5 cm/sec. RESULTS: Tissue Doppler imaging identified diastolic dysfunction in 26.6% of diabetics, while classical criteria did so in 40.5% of the cases. The group identified by classical criteria did not differ significantly from patients without diastolic dysfunction, while in the group identified by Tissue Doppler imaging, significant differences were highlighted, including worse exercise tolerance and higher left ventricular mass index. Moreover, in multiple regression analysis, Em myocardial velocity and body mass index were the only variables independently related to exercise tolerance. CONCLUSION: Differently from classical criteria based on pulsed Doppler, Tissue Doppler imaging identifies a group of asymptomatic normotensive diabetics with diastolic dysfunction and reduced exercise tolerance. Confirmation of the prognostic importance of our findings could justify the use of Tissue Doppler imaging for diastolic function assessment in diabetics with otherwise healthy hearts.
Subject(s)
Diabetes Mellitus/physiopathology , Echocardiography, Doppler , Exercise Tolerance , Ventricular Dysfunction, Left/diagnostic imaging , Adult , Blood Pressure , Diabetes Complications , Diastole , Female , Humans , Male , Middle Aged , Ventricular Dysfunction, Left/complicationsABSTRACT
Na mulher, os androgênios decrescem lenta e progressivamente a partir da quarta década e por toda a vida. O declínio dos androgênios pode gerar um estado de deficiência que se manifesta insidiosamente por diminuicão da funcão sexual, bem estar e energia, alteracões na composicão corporal e perda de massa óssea. Se há história de ooforectomia bilateral, pan-hipopituitarismo, supressão da androgênese adrenal e/ou os níveis séricos de testosterona biodisponível se encontram reduzidos, é provável que estes sinais e sintomas sejam aliviados pela administracão criteriosa de androgênios, cuja prática tem se difundido. Nas doses atualmente preconizadas, parece que os benefícios sobre massa óssea, sexualidade e qualidade de vida são alcancados sem importantes efeitos colaterais de virilizacão. Entretanto, trabalhos bem controlados são necessários para validar a hipótese de que a administracão terapêutica de androgênios em mulheres não tem, a longo prazo, repercussões significativas na incidência sobre câncer de mama ou conseqüências metabólicas indesejáveis.
Subject(s)
Humans , Female , Androgens/deficiency , Androgens/therapeutic use , Hormone Replacement Therapy , Menopause/physiology , Androgens/adverse effects , Body Composition/drug effects , Bone Density/drug effects , Breast Neoplasms/chemically induced , Cardiovascular Diseases/chemically induced , Gonadal Steroid Hormones/metabolism , Hormone Replacement Therapy/adverse effects , Sexual Behavior/drug effects , Testosterone/bloodABSTRACT
Distúrbios no eixo cálcio-PTH-vitamina D são freqüentemente associados às doenças hepáticas crônicas (DHC). Já foi demonstrado que pacientes com DHC apresentam uma tendência à diminuição do cálcio e vitamina D, com aumento compensatório do PTH. Embora a diminuição da hidroxilação da vitamina D em 25 (OH) vitamina D fosse considerada o mecanismo principal destas alterações, estudos recentes vêm demonstrando que, mesmo nos estágios avançados de doença, o fígado ainda consegue manter níveis adequados de 25 (OH) vitamina D. Desta forma, outros fatores (ex: dieta inadequada, diminuição da exposição à luz solar) seriam os responsáveis pelas alterações no eixo cálcio-PTH-vitamina D. Além disso, o tratamento das DHC com glicocorticóides (fibrose cística) e ribavirina (Hepatite C) parece contribuir como agravante destes distúrbios. Por outro lado, parece ser a osteoporose, e não a osteomalácia ou o hiperparatireoidismo secundário, a principal alteração nas DHC. Assim, continua objeto de discussão o papel das alterações do eixo cálcio-PTH-vitamina D na osteodistrofia hepática.
Subject(s)
Humans , Calcium/metabolism , Liver Diseases/metabolism , Liver Diseases/physiopathology , Parathyroid Hormone/metabolism , Vitamin D/metabolism , Bone and Bones/metabolism , Chronic Disease , Calcium/physiology , Parathyroid Hormone/physiology , Vitamin D/physiologyABSTRACT
Disturbances in Calcium-PTH-Vitamin D axis are frequently associated with chronic liver diseases (CLD). In patients with CLD, a trend toward decreased serum calcium and vitamin D has already been demonstrated with compensatory increases in PTH levels. Even though reduced vitamin D hydroxylation has been considered the most important mechanism for these alterations, recent studies demonstrates an adequate production of 25(OH) Vitamin D even in end-stage liver disease. Therefore, other factors (i.e. inadequate diet, reduced exposure to sun light) would be responsible for the disturbances in calcium-PTH-vitamin D axis. Furthermore, antiviral drugs (such as ribavirin for hepatitis C) and glucocorticoids (cystic fibrosis) may also contribute to the worsening of these disturbances. On the other hand, osteoporosis, but not osteomalacia or secondary hyperparathyroidism, seems to be the main alteration in CLD. Thus, the clinical relevance of calcium-PTH-vitamin D disturbances in hepatic osteodystrophy is still under discussion.
