losartan-potassium and Hypogonadism

Endocrine abnormalities are common in patients with chronic kidney disease (CKD) and lead to sexual dysfunction, anemia, hyperparathyroidism, and altered mineral metabolism. Common clinical problems include disturbances in menstruation in women, erectile dysfunction in men, and decreased libido and infertility in both sexes. Organic factors tend to be prominent and are related to uremia and other comorbid illnesses. Psychological factors and depression may exacerbate the primary problem. Alterations in the hypothalamic-pituitary axis are seen early in CKD and tend to worsen after patients start dialysis. Hypogonadism plays a dominant role in male sexual function, whereas changes in hypothalamic-pituitary function predominate in female sexual dysfunction. In patients on dialysis, treatment strategies include optimizing dose of dialysis, correction of anemia with erythropoietin, and correction of hyperparathyroidism. Successful kidney transplantation may restore normal sexual function, especially in younger patients.

Topics: Androgens; Chronic Disease; Erythropoietin; Female; Hormone Replacement Therapy; Humans; Hypogonadism; Kidney Diseases; Kidney Transplantation; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Recombinant Proteins; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Testosterone

As the syndrome of hypogonadotropic hypogonadism (HH) is associated with anaemia and the administration of testosterone restores haematocrit to normal, we investigated the potential underlying mechanisms.. Randomized, double-blind, placebo-controlled trial.. We measured basal serum concentrations of erythropoietin, iron, iron binding capacity, transferrin (saturated and unsaturated), ferritin and hepcidin and the expression of ferroportin and transferrin receptor (TR) in peripheral blood mononuclear cells (MNC) of 94 men with type 2 diabetes. Forty-four men had HH (defined as subnormal free testosterone along with low or normal LH concentrations) while 50 were eugonadal. Men with HH were randomized to testosterone or placebo treatment every 2 weeks for 15 weeks. Blood samples were collected at baseline, 3 and 15 weeks after starting treatment. Twenty men in testosterone group and 14 men in placebo group completed the study.. Haematocrit levels were lower in men with HH (41·1 ± 3·9% vs 43·8 ± 3·4%, P = 0·001). There were no differences in plasma concentrations of hepcidin, ferritin, erythropoietin, transferrin or iron, or in the expression of ferroportin or TR in MNC among HH and eugonadal men. Haematocrit increased to 45·3 ± 4·5%, hepcidin decreased by 28 ± 7% and erythropoietin increased by 21 ± 7% after testosterone therapy (P < 0·05). There was no significant change in ferritin concentrations, but transferrin concentration increased while transferrin saturation and iron concentrations decreased (P < 0·05). Ferroportin and TR mRNA expression in MNC increased by 70 ± 13% and 43 ± 10%, respectively (P < 0·01), after testosterone therapy.. The increase in haematocrit following testosterone therapy is associated with an increase in erythropoietin, the suppression of hepcidin, and an increase in the expression of ferroportin and TR.

Topics: Adult; Aged; Cation Transport Proteins; Diabetes Mellitus, Type 2; Double-Blind Method; Erythropoietin; Ferritins; Hematocrit; Hepcidins; Humans; Hypogonadism; Iron; Leukocytes, Mononuclear; Male; Middle Aged; Receptors, Transferrin; Testosterone

Testosterone formulations that have more steady-state pharmacokinetics, such as subcutaneously implanted testosterone pellets, may cause less erythrocytosis than i.m. injections of shorter acting androgen esters. We, therefore, sought to define the prevalence, predictors, and proximate basis (role of erythropoietin) for polycythemia (hematocrit >0.50) in hypogonadal men receiving testosterone implants long term.. A cross-sectional study was conducted in an academic andrology center with a longitudinal subgroup analysis.. A total of 158 hypogonadal men aged 14-84 years (mean age 46.7 years) treated on average for 8 years (range 0-21 years).. Trough blood testosterone and hematocrit. Serial serum erythropoietin concentrations were measured in 16 volunteers.. Positive univariate associations between polycythemia (hematocrit >0.50) and log(testosterone) (odds ratio (OR) 24.7, 95% confidence interval (CI): 4.3, 141.2, P<0.01) and age (OR 1.1, 95% CI: 1.0, 1.1, P=0.03) and a borderline relationship with current smoking (OR 4.2, 95% CI: 0.9, 20.0, P=0.08) were unveiled. A sensitivity analysis using alternate definitions of polycythemia was performed to capture all potential covariants. Multivariate regression analysis incorporating all potential covariants disclosed the independent OR of developing polycythemia (after adjusting for smoking and age) for log(testosterone) to be 15.0 (95% CI: 2.5, 90.8). Duration of testosterone therapy did not alter the risk of polycythemia. A direct relationship between testosterone and erythropoietin was observed (P=0.05).. Higher trough serum testosterone concentrations but not duration of treatment predict the development of polycythemia in men receiving long-acting depot testosterone treatment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Androgens; Drug Implants; Erythropoietin; Hematocrit; Humans; Hypogonadism; Injections, Subcutaneous; Logistic Models; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Polycythemia; Predictive Value of Tests; Prevalence; Testosterone; Young Adult

Topics: Androgens; Anemia; Drug Therapy, Combination; Erythropoietin; Humans; Hypogonadism; Male; Neoplasms; Recombinant Proteins

Juvenile hemochromatosis is a rare genetic disorder that causes iron overload. Clinical complications, which include liver cirrhosis, heart failure, hypogonadotropic hypogonadism and diabetes, appear earlier and are more severe than in HFE-related hemochromatosis. This disorder, therefore, requires an aggressive therapeutic approach to achieve iron depletion. We report here the case of a young Italian female with juvenile hemochromatosis who was unable to tolerate frequent phlebotomy because of coexistent ss-thalassemia trait. The patient was successfully iron-depleted by combining phlebotomy with recombinant human erythropoietin.

Topics: Adrenal Cortex Hormones; Adrenal Insufficiency; Adult; Arrhythmias, Cardiac; beta-Thalassemia; Chelation Therapy; Chromosomes, Human, Pair 1; Deferoxamine; Erythropoietin; Estrogen Replacement Therapy; Female; Hemochromatosis; Hemosiderosis; Hormone Replacement Therapy; Humans; Hypogonadism; Liver Cirrhosis; Phlebotomy; Progesterone; Recombinant Proteins

Six females and six males with carbohydrate-deficient glycoprotein (CDG) syndrome type I, aged 4 months to 43 years, were examined for gonadal function and electrophoretic isoform patterns of four glycoprotein hormones: FSH, LH, TSH and erythropoietin. The female patients had a hypergonadotrophic hypogonadism from an early age without detectable ovaries in three cases. In the males, testosterone levels tended to be low with normal or slightly raised gonadotrophin values. None of the four glycoprotein hormone showed any signs of carbohydrate deficiency of the same type as in many liver-synthesized circulating glycoproteins. It is concluded that females with CDG syndrome type I have primary ovarian failure, and that the syndrome does not affect the terminal charged carbohydrate portion in gonadotrophins, TSH or erythropoietin. The characteristic carbohydrate deficiency in some circulating glycoproteins is thus not a generalized feature in this disease.

Topics: Adolescent; Adult; Biomarkers; Carbohydrate Metabolism, Inborn Errors; Child; Erythropoietin; Female; Follicle Stimulating Hormone; Glycoproteins; Humans; Hypogonadism; Infant; Isoelectric Focusing; Luteinizing Hormone; Male; Pituitary Hormones, Anterior; Thyrotropin; Transferrin

Topics: Adult; Bromocriptine; Chronic Disease; Drug Evaluation; Erythropoietin; Humans; Hypogonadism; Kidney Failure, Chronic; Male; Middle Aged; Penile Erection; Recombinant Proteins; Renal Dialysis; Spermatogenesis; Sulfates; Uremia; Zinc; Zinc Sulfate

Topics: Adult; Aged; Androgens; Anemia; Bone Marrow Examination; Chromium Isotopes; Erythrocyte Count; Erythropoiesis; Erythropoietin; Female; Hematocrit; Hemoglobinometry; Humans; Hypogonadism; Iron; Lymphoma; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Transaminases