Oral testosterone undecanoate reverses erectile dysfunction associated with diabetes mellitus in patients failing on sildenafil citrate therapy alone.

AIMS: To evaluate the cause of failure of sildenafil citrate (Viagra) to restore erections in patients with organic erectile dysfunction (ED) associated with type II diabetes mellitus (DM) and receiving oral antidiabetic drugs. METHODS: Diabetic ED patients (n = 120), aged 43-74 years, failing to respond at least three times to 100 mg Viagra were evaluated. After at least 2 weeks' treatment with oral testosterone undecanoate (Andriol), 100 mg Viagra was used before coitus. ED was assessed with the International Index of Erectile Function (IIEF). Serum total testosterone, prolactin, thyroid stimulating hormone, lipid profile and prostate-specific antigen (PSA) were determined by standard methods and prostate volume by digital rectal examination. Age-matched diabetic ED patients (n = 100) served as controls for baseline values. RESULTS: Viagra non-responders had, at baseline, significantly lower testosterone and more depressed libido than controls. Andriol restored testosterone to normal levels and increased libido. In 84/120 (70%) Viagra non-responders, combined therapy with Andriol induced satisfactory erections, a significant increase in IIEF scale (question (Q) 3 from 2.0 +/- 0.2 to 3.7 +/- 0.3, Q4 from 1.9 +/- 0.1 to 3.4 +/- 0.2, Q12 from 1.0 +/- 0.1 to 4.2 +/- 0.4) and increased sexual contacts from 0.5 to 3-4 per month. No adverse events were noted, and PSA levels remained below 4 ng/ml. CONCLUSION: Decreased testosterone levels in patients with ED and type II DM receiving oral antidiabetic against may be responsible for failure to respond to sildenafil citrate therapy. Combination with oral testosterone undecanoate restores sexual function in these patients.

[Sildenafil citrate (viagra) treatment in patients with diabetes mellitus]. / Opyt primeneniia sildenafila tsitrata (viagry) u patsientov s sakharnym diabetom.

AIM: To evaluate different dosages of vasoactive drug viagra in patients with erectile dysfunction suffering from diabetes mellitus (DM) type I and II. MATERIALS AND METHODS: Viagra in doses 25, 50 and 100 mg was given to 30 DM patients with different forms of erectile dysfunction. RESULTS: The response was obtained in 70.3% of cases. The highest effect was achieved with the dose 100 mg (the response rate 68.5% of patients). The dose 50 mg was effective in 31.5%, 25 mg in 0% of patients. Most nonresponders had low testosterone levels in the blood.

[The hypothalamo-hypophyseal system in patients with multinodular colloid euthyroid goiter]. / Sostoianie gipotalamo-gipofizarnoi sistemy u bol'nykh s mnogouzlovym kolloidnym éutireoidnym zobom.

Eighty patients with multinodular colloidal euthyroid goiter were examined. Thyrotropin-releasing hormone (TRH) test was carried out in 22 patients and 7 healthy women. The results of the test indicate a clear-cut tendency to reduction of hypophyseal TTH reserve in patients with multinodular euthyroid goiter with enlarged thyroid. In other words, clinical diagnosis of an euthyroid condition in the examinees appears to be groundless, particularly in patients with stage IV multinodular euthyroid goiter who may be referred to latent hyperthyrosis group on the basis of TRH test results. Three types of STH reaction were revealed by TRH test in these patients. The authors put forward a hypothesis on STH contribution as a growth factor to the pathogenesis of multinodular colloid euthyroid goiter.

[Spermatogenesis disorders in transsexual patients]. / Narusheniia spermatogeneza u bol'nykh transseksualizmom.

Examinations of the semen in 8 patients with male transsexualism revealed stereotypical changes in spermograms ranging from oligo- to azoospermia. Possible mechanisms responsible for this abnormality are discussed.

[Association of multinodular euthyroid colloid goiter with various genetic markers]. / Ob assotsiatsii mnogouzlovogo kolloidnogo éutireoidnogo zoba s nekotorymi geneticheskimi markerami.

Distribution of blood groups ABO, Rh, P1, and MN was studied in 85 patients with multinodular euthyroid colloid goitre. An association has been revealed between the presence of this disease and MN blood group, as well as the absence of P1 antigen. These results permit us considering MN blood group and P1 antigen absence as factors of risk for multinodular euthyroid colloid goitre.

[The relationship of endocrine ophthalmopathy to the thyroid status and to the indices of an autoimmune lesion of the thyroid]. / Sviaz' éndokrinnoi oftal'mopatii s tireoidnym statusom i pokazateliami autoimmunnogo porazheniia shchitovidnoi zhelezy.

The paper is devoted to a study of the pathogenetic relationship of endocrine ophthalmopathy with thyroid diseases. Altogether 76 patients with endocrine ophthalmopathy combined with various thyroid lesions (diffuse toxic goiter, Hashimoto's disease, primary hypothyrosis) and without thyroid diseases were investigated. The serum level of thyroid hormones, the content of Ig A, M, G, thyroglobulin and the presence of antithyroid antibodies were analyzed. HLA typing by A, B, C, D2 loci was done for a group of patients. The results did not show correlation of the origin and gravity of ophthalmopathy either with thyroid function or with the factors determining thyroid affection. Some differences in the genetic markers of endocrine ophthalmopathy and autoimmune thyroid diseases were also established.

[The sexual function of men with acromegaly]. / Sostoianie polovoi funktsii u muzhchin, bol'nykh akromegaliei.

Some acromegalic male patients (50%) have weakened sexual function accompanied by a decrease in the levels of LH, FSH and testosterone. Hyperprolactinemia of various degrees was observed in 11 of 13 patients (84%). The summary index SFM (the male sexual formula) and a PRL level showed negative correlation. There was no significant difference in LH response to LH-RH administration between patients with normal and disturbed sexual function. Radiation therapy, in particular proton-beam therapy, produced no negative influence on male sexual function in a long-term period after therapy.

[The clinical "masks" of Hashimoto's goiter (the problems of diagnosis)]. / Klinicheskie "maski" zoba Khashimoto (voprosy diagnostiki).

Retrospective analysis of 240 case records of patients with histologically verified Hashimoto's disease has shown that in 62% it was masked by some other thyroid diseases, especially by multinodular and nodular euthyroid goiter. The most effective diagnosis before operation was made in patients using fine needle aspiration puncture biopsy whereas other methods were auxiliary.

[Disorders of blood coagulation and microcirculation in diabetics]. / Narusheniia gemokoaguliatsii i mikrotsirkuliatsii u bol'nykh sakharnym diabetom.

Determination of platelet aggregation and disaggregation and the use of coagulogram indices reflecting the main stages of blood coagulation (the levels of fibrinogen and soluble complexes of fibrin-monomer, fibrinolytic activity) are recommended for the diagnosis of chronic DIC-syndrome in patients with diabetes mellitus. This syndrome is noted in diabetic patients before the development of clinical symptoms of microangiopathy but in parallel with microcirculatory disorders according to the results of conjunctival biomicroscopy. Platelet aggregation indices show correlation with the conjunctival index in diabetic patients even before the development of a clinical picture of diabetic retinopathy.

[Sperm characterization in patients with diabetes mellitus suffering from sexual disorders]. / Kharakteristika spermy u bol'nykh sakharnym diabetom, stradaiushchikh seksual'nymi rasstroistvami.

A total of 54 male patients suffering from type I and II diabetes mellitus of different gravity were investigated. A higher percentage of immobile and pathological types of spermatozoa was revealed in patients with a severe type of diabetes mellitus.

[Hypothalamo-mesencephalic crises in endocrine diseases]. / Gipotalomo-mezéntsefal'nye krizy pri éndokrinnykh zabolevaniiakh.

Altogether 261 patients with different vegetative crises were investigated by clinico-neurologic, electro-, rheo-, echoencephalographic methods. The most frequent causes of crises (in 140 patients) were disorders of the hypothalamic and hypothalamo-mesencephalic sections of the brain. In the rest of the patients crises were caused by neuroses, disorders of the caudal zones of the brain stem and temporal region, pheochromocytoma, insulinoma, primary hyperaldosteronism, hypoparathyroidism and other diseases. Criteria of differential diagnosis of hypothalamic crises and crises in neuroses, disorders of the distal sections of the brain stem and temporal lobe epilepsy were specified. Some new, quite informative clinico-neurological and rheo- and electroencephalographic criteria were proposed for the differentiation of hypothalamic crises and crises in pheochromocytoma, insulinoma and primary hyperaldosteronism.

[Hypogonadotropic hypogonadism combined with anosmia (Kallmann's syndrome)]. / Gipogonadotropnyi gipogonadizm, sochetaiushchiisia s anosmiei (sindrom Kallmanna).

Diagnosis in Kallmann's syndrome is often erroneous and results in the administration of inadequate therapy. The aim of the study was to define characteristic features of a course of disease and to administer adequate therapy. It has been established that cases of Kallmann's syndrome are rather frequent. Patients with hypogonadism should be examined with respect to anosmia because such a combination suggests the diagnosis of Kallmann's syndrome. The selection of a therapeutic method should be strictly individual bearing in mind a degree of hypoplasia and the presence of cryptorchism. In the combination of Kallmann's syndrome with cryptorchism CG therapy results in the elimination of cryptorchism without surgery in most patients. Chorionic gonadotropin should be administered in combination with androgens in marked testicular hypoplasia in any period at the reproductive age; later on it can be only chorionic gonadotropin. Correct diagnosis and adequate therapy lead to sex and social rehabilitation of patients with Kallmann's syndrome decreasing the number of sterile men.

[Diagnostic value of the luliberin test with patients with polycystic ovaries]. / Diagnosticheskaia tsennost' proby s liuliberinom u bol'nykh polikistozom iaichnikov.

Gonadotropic function was investigated and the diagnostic value of the test with luteinizing hormone releasing factor (LHRF) was assessed in patients with polycystic ovaries. For this purpose a 100 micrograms dose of LHRF was intravenously jet injected to 10 patients with nonspecific polycystic ovaries. Levels of luteinizing and follicle stimulating hormones (LH and FSH) were determined before the injection and 15, 30, 60, 90 or 120 minutes after it. Patients with nonspecific polycystic ovaries compared with those who had specific pattern of the disease or with normal women showed elevated basal LH levels which significantly increased in response to LHRF administration. In patients with specific form of the disease the FSH response to the injection was inhibited while LN basal levels as well as its response to LHRF were the same as in healthy women. In 13 out of 15 patients (3 out of 4 amenorrheic females among them) the preparation displayed its ovulatory affect after a single diagnostic dose. Desirability of LHRF use for a differential diagnosis of polycystic ovaries or for therapeutic stimulation of ovulation was suggested.

[Lactotropic and thyrotropic functions of the hypophysis in polycystic ovary syndrome]. / Laktotropnaia i tireotropnaia funktsii gipofiza pri polikistoze iaichnikov.

An increase in the prolactin basal level was detected in 8 out of 50 patients with ovarian polycystosis. A test with TRH and a simultaneous determination of the levels of prolactin, TTH, T3, T4 were used in 25 patients, of them a hyperergic reaction of prolactin to TRH was detected in 5. A correlation analysis of function of the thyroid was performed. Positive correlation between the levels of prolactin and TTH in patients with hyperprolactinemia and between a maximum increment in percentage to the initial level of TTH and prolactin in patients with a hyperergic reaction of prolactin to TRH was revealed. A conclusion was made of the common nature of disorder in the mechanisms of regulation of prolactin and thyroid function in patients with ovarian polycystosis.