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Abbas D, Ciricillo JA, Elom HA, Moon AM. Extrahepatic Health Effects of Alcohol Use and Alcohol-associated Liver Disease. Clin Ther 2023; 45:1201-1211. [PMID: 37806811 DOI: 10.1016/j.clinthera.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Alcohol use disorder (AUD) is a growing public health concern and an important contributor to global morbidity and mortality. While the hepatotoxic effects of alcohol are well known, the adverse effects of alcohol are manifested in almost every organ system. With the growing public health impact of AUD, the aim of this narrative review is to highlight the epidemiology and burden of AUD and its association with extrahepatic diseases including malignancy and disorders of the gastrointestinal (GI), cardiovascular, immunologic, neurologic, endocrine, and hematologic systems. METHODS A narrative review of the literature was performed to identify studies addressing the epidemiology, pathophysiology, clinical manifestations, and therapy of extrahepatic health manifestations of alcohol use. FINDINGS In the United States, an estimated 14.5 million people have AUD and approximately 88,000 adults die yearly due to alcohol-related causes. The consumption of alcohol and AUD is associated with injuries, violence, cancers, nonmalignant conditions of the GI system, infections, effects on the cardiovascular system, and neurodegenerative diseases. These conditions contribute to the increased mortality associated with AUD and are burdensome to patients and caregivers. IMPLICATIONS Increased awareness of the extrahepatic manifestations of AUD, screening for AUD using validated screening tools, such as the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score, and offering evidence-based interventions to patients with AUD is imperative to reduce the public health burden of AUD. Although historically controversial, recent evidence suggests that any level of alcohol consumption can have negative health consequences. Further research is warranted to determine if any amount of alcohol is safe for consumption. Public health efforts are warranted to help curtail the growing burden of AUD.
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Affiliation(s)
- Daniyal Abbas
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Jacob A Ciricillo
- Department of Internal Medicine, University of Cincinnati Medicine Center, Cincinnati, Ohio
| | - Hilary A Elom
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Andrew M Moon
- Department of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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Zang G, Sun X, Sun Y, Zhao Y, Dong Y, Pang K, Cheng P, Wang M, Zheng Y. Chronic liver diseases and erectile dysfunction. Front Public Health 2023; 10:1092353. [PMID: 36684968 PMCID: PMC9853559 DOI: 10.3389/fpubh.2022.1092353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Chronic liver diseases (CLDs) are characterized by progressive necrosis of hepatocytes, which leads to liver fibrosis and cirrhosis, and ultimately liver dysfunction. The statistics of 2020 shows that the number of patients with CLDs, including chronic hepatitis, fatty liver, and cirrhosis, may exceed 447 million in China. The liver is a crucial organ for the metabolism of various substances, including sex hormones and lipids. CLDs frequently result in abnormalities in the metabolism of sex hormones, glucose, and lipids, as well as mental and psychological illnesses, all of which are significant risk factors for erectile dysfunction (ED). It has been reported that the prevalence of ED in male patients with CLDs ranges from 24.6 to 85.0%. According to a survey of Caucasians, liver transplantation may improve the erectile function of CLDs patients with ED. This finding supports the link between CLDs and ED. In addition, ED is often a precursor to a variety of chronic diseases. Given this correlation and the significant prevalence of CLDs, it is important to evaluate the epidemiology, risk factors, etiology, and treatment outcomes of ED in male patients with CLDs, expecting to attract widespread attention.
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Affiliation(s)
- Guanghui Zang
- Department of Urology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Xv Sun
- Graduate School, Bengbu Medical College, Bengbu, Anhui, China
| | - Yufeng Sun
- Department of Urology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Yan Zhao
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Yang Dong
- Department of Urology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Kun Pang
- Department of Urology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Ping Cheng
- Graduate School, Bengbu Medical College, Bengbu, Anhui, China
| | - Meng Wang
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Yuli Zheng
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
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Lima TB, Santos LAA, Nunes HRDC, Silva GF, Caramori CA, Qi X, Romeiro FG. Safety and efficacy of risedronate for patients with esophageal varices and liver cirrhosis: a non-randomized clinical trial. Sci Rep 2019; 9:18958. [PMID: 31831865 PMCID: PMC6908659 DOI: 10.1038/s41598-019-55603-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023] Open
Abstract
Despite the high prevalence of osteoporosis in liver cirrhosis, the indication of bisphosphonates for patients with esophageal varices has been avoided due to risk of digestive mucosal damage. Therefore, this study aimed to evaluate the safety profile of risedronate treatment for patients with osteoporosis, liver cirrhosis and esophageal varices with low risk of bleeding. A total of 120 patients were allocated into two groups according to their bone mineral density measured by dual-energy X-ray absorptiometry. In the intervention group, 57 subjects with osteoporosis received oral risedronate at 35 mg weekly plus daily calcium and vitamin D supplementation. In the control group, 63 subjects with osteopenia received only calcium and vitamin D. The groups received the treatment for one year and underwent surveillance endoscopies at six and 12 months, as well as a control dual-energy X-ray absorptiometry after a 12-month follow-up. The study received Institutional Review Board approval. The groups had not only comparable Model for End-stage Liver Disease score and esophageal varices degree, but also similar incidence of digestive adverse effects. A significant improvement was achieved in the intervention group in the lumbar spine T score (p < 0.001). The results suggest that risedronate may be safely used in liver cirrhosis and esophageal varices with low bleeding risk under endoscopic surveillance, thus allowing bone mass recovery.
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Affiliation(s)
- Talles Bazeia Lima
- Internal Medicine Department, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, São Paulo, Brazil
| | - Lívia Alves Amaral Santos
- Internal Medicine Department, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, São Paulo, Brazil
| | | | - Giovanni Faria Silva
- Internal Medicine Department, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, São Paulo, Brazil
| | - Carlos Antonio Caramori
- Internal Medicine Department, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, São Paulo, Brazil
| | - Xingshun Qi
- General Hospital of Shenyang Military Command, Liaoning, Sheng, China
| | - Fernando Gomes Romeiro
- Internal Medicine Department, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, São Paulo, Brazil.
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Neong SF, Billington EO, Congly SE. Sexual Dysfunction and Sex Hormone Abnormalities in Patients With Cirrhosis: Review of Pathogenesis and Management. Hepatology 2019; 69:2683-2695. [PMID: 30468515 DOI: 10.1002/hep.30359] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/06/2018] [Indexed: 02/06/2023]
Abstract
Healthy sexual function is important to maintain a good quality of life but is frequently impaired in patients with cirrhosis. The degree of sexual dysfunction appears to be linked with the degree of hepatic dysfunction. In men, sexual dysfunction can be related to the hyperestrogenism of portal hypertension and/or to decreased testosterone resulting from testicular dysfunction. In women, suppression of the hypothalamic-pituitary-gonadal axis appears to be a principal contributor, with no significant effect of portal hypertension. There is also a huge psychological barrier to break through as there is a component of depression in many patients with cirrhosis. Sexual dysfunction is often underdiagnosed in the cohort with cirrhosis. Management of sexual disorders in patients with cirrhosis can be challenging as they are often multifactorial. A multidisciplinary approach is key in managing these patients. We review the current literature on the pathogenesis of sexual dysfunction in patients with cirrhosis and propose a stepwise algorithm to better manage these patients.
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Affiliation(s)
- Shuet Fong Neong
- Multiorgan Transplant, University Health Network, Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emma O Billington
- Division of Endocrinology & Metabolism, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen E Congly
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
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Correlations between sex-related hormones, alcohol dependence and alcohol craving. Drug Alcohol Depend 2019; 197:183-190. [PMID: 30840924 DOI: 10.1016/j.drugalcdep.2019.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/14/2019] [Accepted: 01/20/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Sex-related differences in the susceptibility, progression, and treatment response in alcohol-dependent subjects have been repeatedly reported. In this study, we aimed to investigate the associations of the sex-related hormone/protein levels with alcohol dependence (AD) and alcohol craving in male and female subjects. METHODS Plasma sex-related hormones (estradiol, estrone, total testosterone, progesterone, follicle stimulated hormone [FSH], luteinizing hormone), and sex hormone binding globulin were measured by mass spectrometry or automated immunoassays from 44 recently-abstained subjects (29 males and 15 females; mean age = 45.9 ± 15.6) meeting DSM-IV-TR criteria for AD and 44 age-, sex- and race-matched non-AD controls. Conditional logistic regression was conducted to examine the association of sex-related hormone and protein levels with AD risk, accounting for matching variables. Their associations with alcohol craving scales (Penn Alcohol Craving Scale and Inventory of Drug-Taking Situations) were assessed in AD subjects. RESULTS Plasma FSH level was significantly higher in AD males (10.3 ± 9.8 IU/L) than control males (8.0 ± 15.9 IU/L; p = 0.005, pcorrected = 0.035). We also found a significant inverse correlation of FSH level with propensity to drink in negative emotional situations (Spearman's rho=-.540; p = 0.021) and positive correlations between progesterone level and craving intensity (Spearman's rho=.464; p = 0.020) and between total testosterone level and propensity to drink under temptations (adjusted for no-drinking days; β=6.496; p = 0.041) in AD males. CONCLUSIONS These results suggest that FSH, progesterone, and testosterone levels may be associated with AD and alcohol craving in AD males. Future research is needed to replicate these findings and investigate the underlying biological mechanisms.
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Snelling C, Tanchuck-Nipper MA, Ford MM, Jensen JP, Cozzoli DK, Ramaker MJ, Helms M, Crabbe JC, Rossi DJ, Finn DA. Quantification of ten neuroactive steroids in plasma in Withdrawal Seizure-Prone and -Resistant mice during chronic ethanol withdrawal. Psychopharmacology (Berl) 2014; 231:3401-14. [PMID: 24871700 PMCID: PMC4134998 DOI: 10.1007/s00213-014-3618-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 05/08/2014] [Indexed: 12/22/2022]
Abstract
RATIONALE The rapid membrane actions of neuroactive steroids, particularly via an enhancement of γ-aminobutyric acidA receptors (GABAARs), participate in the regulation of central nervous system excitability. Prior evidence suggests an inverse relationship between endogenous GABAergic neuroactive steroid levels and behavioral changes in excitability during ethanol withdrawal. OBJECTIVES Previously, we found that ethanol withdrawal significantly decreased plasma allopregnanolone (ALLO) levels, a potent GABAergic neuroactive steroid, and decreased GABAAR sensitivity to ALLO in Withdrawal Seizure-Prone (WSP) but not in Withdrawal Seizure-Resistant (WSR) mice. However, the effect of ethanol withdrawal on levels of other endogenous GABAAR-active steroids is not known. METHODS After validation of a gas chromatography-mass spectrometry method for the simultaneous quantification of ten neuroactive steroids, we analyzed plasma from control male WSP-1 and WSR-1 mice and during ethanol withdrawal. RESULTS We quantified levels of nine neuroactive steroids in WSP-1 and WSR-1 plasma; levels of pregnanolone were not detectable. Basal levels of five neuroactive steroids were higher in WSR-1 versus WSP-1 mice. Ethanol withdrawal significantly suppressed five neuroactive steroids in WSP-1 and WSR-1 mice, including ALLO. CONCLUSIONS Due to lower basal levels of some GABAAR-active steroids in WSP-1 mice, a withdrawal-induced decrease in WSP-1 mice may have a greater physiological consequence than a similar decrease in WSR-1 mice. Because WSP-1 mice also exhibit a reduction in GABAAR sensitivity to neuroactive steroids during withdrawal, it is possible that the combined decrease in neuroactive steroids and GABAAR sensitivity during ethanol withdrawal in WSP-1 mice represents a neurochemical substrate for severe ethanol withdrawal.
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Affiliation(s)
- Christopher Snelling
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
| | | | - Matthew M. Ford
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Jeremiah P. Jensen
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
| | - Debra K. Cozzoli
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
| | - Marcia J. Ramaker
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
| | - Melinda Helms
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
| | - John C. Crabbe
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
- Portland Alcohol Research Center, Department of Veterans Affairs Medical Center, Portland OR
| | - David J. Rossi
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
| | - Deborah A. Finn
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR
- Portland Alcohol Research Center, Department of Veterans Affairs Medical Center, Portland OR
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Kent K, Butler K, Wood RI. Ethanol induces conditioned social preference in male mice. Alcohol Clin Exp Res 2014; 38:1184-92. [PMID: 24460901 DOI: 10.1111/acer.12342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/06/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Affiliative social interactions promote alcohol consumption, and alcohol also promotes affiliative behavior. Furthermore, for most species, moderate doses of ethanol (EtOH) and social affiliation are each rewarding. However, animal studies of drug and EtOH reward typically test individuals in isolation. To address social dimensions of EtOH reward, this study tested EtOH-induced conditioned social preference in male C57BL/6 mice with (ORCHX+T) and without (ORCHX) testosterone. METHODS ORCHX+T males received EtOH (0, 1, 2, or 3 g/kg) intraperitoneally and were paired 4× for 30 minutes each with 1 of 2 stimulus males: with the CS- stimulus male after saline injection and with the CS+ male following EtOH. After pairing, time spent with CS+ and CS- males was measured in a 10-minute test. RESULTS ORCHX+T test males showed conditioned preference for the CS+ male in response to 3 g/kg EtOH (change in preference: +71.3 ± 30.0 s/10 min, p < 0.05), but not for 0, 1, or 2 g/kg. By contrast, ORCHX males did not demonstrate conditioned preference for 3 g/kg EtOH (+16.0 ± 24.3 s/10 min, p > 0.05). In separate groups of mice, stimulus males (IS+) received EtOH during pairing to determine whether test mice prefer another intoxicated mouse. Both ORCHX+T and ORCHX test mice showed an increase in preference score for the IS+ mouse (ORCHX+T: +68.1 ± 24.0 seconds; ORCHX: +58.9 ± 19.6 seconds, p < 0.05). CONCLUSIONS These data demonstrate that EtOH promotes social preference in male mice, as it does in females. Testosterone enhances this effect.
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Affiliation(s)
- Kelly Kent
- Department of Cell and Neurobiology , Keck School of Medicine of the University of Southern California, Los Angeles, California; Neuroscience Graduate Program, University of Southern California, Los Angeles, California
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Abstract
Chronic consumption of a large amount of alcohol disrupts the communication between nervous, endocrine, and immune system and causes hormonal disturbances that lead to profound and serious consequences at physiologic and behavioral levels. These alcohol-induced hormonal dysregulations affect the entire body and can result in various disorders such as stress abnormalities, reproductive deficits, body growth defect, thyroid problems, immune dysfunction, cancers, bone disease, and psychological and behavioral disorders. This review summarizes the findings from human and animal studies that provide consistent evidence on the various effects of alcohol abuse on the endocrine system.
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Affiliation(s)
- Nadia Rachdaoui
- Nadia Rachdaoui, Ph.D., Rutgers Endocrine Research Program. Department of Animal Sciences Rutgers University, 67 Poultry Farm Lane, New Brunswick, NJ 08901,
| | - Dipak K. Sarkar
- Dipak K. Sarkar, Ph.D., D. Phil., Rutgers Endocrine Research Program. Department of Animal Sciences, Rutgers University, 67 Poultry Farm Lane, New Brunswick, NJ 08901,
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9
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Physiological levels of estradiol correlate with lipid / lipoprotein profiles in healthy men. Environ Health Prev Med 2012; 4:81-6. [PMID: 21432177 DOI: 10.1007/bf02931999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/1998] [Accepted: 03/24/1999] [Indexed: 10/21/2022] Open
Abstract
In this cross-sectional study, the relationships of the physiological levels of estradiol (E2) and dehydroepiandrosterone-sulfate (DHEA-S) to the lipid and lipoprotein profiles were investigated in 212 apparently healthy men aged from 18 to 59 years old. These subjects were divided into tertiles according to the levels of E2 and DHEA-S, respectively. We performed one-way analysis of variance and analysis of co-variance controlling for age, body mass index, percent body fat, waist to hip ratio, maximal oxygen uptake, alcohol and cigarette consumptions as confounding factors.A lower E2 level was associated with higher concentrations of total cholesterol (TC) and low density lipoprotein cholesterol. A lower DHEA-S level was associated with a lower concentration of high density lipoprotein cholesterol (HDLC) and a higher ratio of TC / HDLC. These correlations remained significant after adjusting for the above confounding factors. Neither free testosterone nor sex hormone-binding globulin was associated with the lipids and lipoproteins. These results suggest that higher levels of E2 and DHEA-S, at least in physiological concentrations, are related to the favorable lipid and lipoprotein levels in men.
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Devoto Canessa E, Lucía Aravena Cerda M. Hipogonadismo hipogonadotropo funcional hipotalámico idiopático pospuberal en el varón. Rev Int Androl 2008. [DOI: 10.1016/s1698-031x(08)75676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Remenár E, Számel I, Budai B, Vincze B, Gaudi I, Gundy S, Kásler M. Increase of hypophyseal hormone levels in male head and neck cancer patients. Pathol Oncol Res 2007; 13:341-4. [PMID: 18158570 DOI: 10.1007/bf02940314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 09/20/2007] [Indexed: 11/29/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) develops in at least 80% of cases in men with a history of smoking and heavy alcohol consumption, still it is only diagnosed in a small proportion of alcoholics. Endocrine milieu is an important factor in carcinogenesis and prognosis of several cancer types. The aim of our study was to investigate sex steroid and hypophyseal hormone status of male HNSCC patients in comparison to healthy volunteers and to patients with alcoholic liver disease, to determine possible hormonal alterations characteristic of cancer. Liver function (GGT level), and serum levels of gonadotropic hormones (FSH, LH, prolactin), sex steroids (estradiol, progesterone, testosterone) and sex hormone-binding globulin (SHBG) were compared in 130 male HNSCC patients, 54 patients with alcoholic liver disease but no known cancer, and 56 healthy controls. We found abnormal values of liver function in both HNSCC patients and alcoholics compared to healthy controls, suggesting the presence of alcoholic liver disease in the former group as well. On the other hand, a significant elevation in the level of DHEA, FSH and LH was observed in cancer patients exclusively. As a conclusion, abnormal alterations in sex steroid hormone levels can frequently be found in HNSCC patients, which may be caused in part by the alcoholic liver damage accompanying the disease. The significant increase in FSH and LH serum levels, observed only in the cancer patients, indicates that these hormones may play a role in the development and/or progression of HNSCC.
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Affiliation(s)
- Eva Remenár
- Department of Head and Neck, Laser and Reconstructive Plastic Surgery, National Institute of Oncology, Budapest, H-1122, Hungary.
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Oliveira MC, Cassal A, Pizarro CB. Avaliação do eixo hipotálamo-hipófise-gônada e prevalência de hipogonadismo central em homens e mulheres com cirrose hepática. ACTA ACUST UNITED AC 2003. [DOI: 10.1590/s0004-27302003000500014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
A cirrose hepática (CH) é uma das doenças crônicas associadas ao hipogonadismo (HG), o qual tem etiologia variada em relação ao órgão-alvo do eixo gonadal que é acometido. Neste estudo avaliamos o HG intercorrente na CH de diferentes etiologias, em 82 pacientes (49 M/33 F). O diagnóstico de HG foi estabelecido em bases clínicas e hormonais e correlacionado com a gravidade da doença hepática. HG não fisiológico foi diagnosticado em 63 casos (76,8%). Nos homens, detectou-se diminuição da libido (68,8%), disfunção erétil (53,8%), pêlos de distribuição ginecóide (53,1%), atrofia testicular (55,3%) e ginecomastia (48%); entre as mulheres, 18 (78,2%) apresentavam amenorréia em idade fértil. HG foi confirmado por níveis baixos de testosterona livre nos homens e de estradiol nas mulheres. Níveis altos de gonadotrofinas basais estabeleceram a etiologia gonadal do HG. O diagnóstico de alteração hipotálamo-hipofisária só foi possível através do teste do GnRH, onde o valor de pico do LH foi significativamente menor nos hipogonádicos. HG central foi predominante: 90,4% dos casos. A duração da hepatopatia não diferiu entre hipo e eugonádicos. A gravidade da CH, avaliada através da classificação de CHILD, mostrou correlação significativa com o HG. Não houve associação significativa entre HG e sintomas isolados como diminuição da libido ou ginecomastia, concomitância de outras doenças, hiperprolactinemia ou uso de drogas. Em conclusão, foram proeminentes os achados em relação à freqüência de HG, especialmente nas mulheres, e a predominância da etiologia central do mesmo, possivelmente em resposta às más condições metabólicas dos pacientes. O diagnóstico de HG nos pacientes com CH demanda atenção médica contínua.
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Affiliation(s)
| | - Alvaro Cassal
- Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre
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Tan RS, Vasudevan D. Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse. Fertil Steril 2003; 79:203-5. [PMID: 12524089 DOI: 10.1016/s0015-0282(02)04550-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report a case of symptomatic hypogonadism induced by the abuse of multiple steroid preparations that was subsequently reversed by clomiphene. DESIGN Case report. SETTING University-affiliated andrology practice within family practice clinic. PATIENT(S) A 30-year-old male. INTERVENTION(S) Clomiphene citrate, 100-mg challenge for 5 days, followed by treatment at same dose for 2 months. MAIN OUTCOME MEASURE(S) Clinical symptoms, androgen decline in aging male questionnaire, total T, FSH, LH. RESULT(S) Reversal of symptoms, normalization of T levels with LH surge, restoration of pituitary-gonadal axis. CONCLUSION(S) Clomiphene citrate is used typically in helping to restore fertility in females. This represents the first case report of the successful use of clomiphene to restore T levels and the pituitary-gonadal axis in a male patient. The axis was previously shut off with multiple anabolic steroid abuse.
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Affiliation(s)
- Robert S Tan
- Department of Family and Community Medicine, University of Texas Health Sciences Center, Houston, Texas 77030, USA.
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Molina-Perez M, Gonzalez-Reimers E, Santolaria-Fernandez F, Martinez-Riera A, Rodriguez-Moreno F, Rodriguez-Rodriguez E, Milena-Abril A, Velasco-Vazquez J. Relative and combined effects of ethanol and protein deficiency on bone histology and mineral metabolism. Alcohol 2000; 20:1-8. [PMID: 10680711 DOI: 10.1016/s0741-8329(99)00048-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study was performed to analyze the relative and combined effects of ethanol and protein deficiency on bone histology and mineral metabolism in 4 groups of 7 animals each which were pair-fed during 8 weeks with 1) a nutritionally adequate diet; 2) a 36% (as energy) ethanol containing isocaloric diet; 3) a 2% protein, isocaloric diet; and 4) a 36% ethanol 2% protein isocaloric diet, respectively, following the Lieber-DeCarli model. Another group of five rats were fed ad libitum the control diet. The first and second lumbar vertebrae were removed after sacrifice, and processed for histomorphometrical analysis of undecalcified bone samples. Blood and 24-h urine were also collected. Protein malnutrition, but not ethanol, leads to osteoporosis and reduced osteoid synthesis, whereas ethanol and protein malnutrition both lead to impaired bone mineral apposition and increased urinary hydroxyproline excretion. These changes are accompanied by an increase in serum parathormone and serum 1,25 dihydroxy vitamin D3, a slight hypomagnesemia, hypercalciuria and hyperphosphaturia; protein deficiency plays an independent role in these alterations, whereas both ethanol and protein deficiency exert independent effects on decreasing serum testosterone levels; this last alteration may contribute to the bone changes mentioned before.
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Affiliation(s)
- M Molina-Perez
- Dpto. de Medicina Interna, Hospital Universitario de Canarias, La Laguna, Tenerife, Canary Islands, Spain
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