Documento básico de consenso sobre el síndrome de hipogonadismo de inicio tardío

Increased Medical Complications, Revisions, In-Hospital Lengths of Stay, and Cost in Patients With Hypogonadism Undergoing Primary Total Knee Arthroplasty

BACKGROUND

Research regarding the impact of hypogonadism following primary total knee arthroplasty (TKA) is limited. Therefore, the purpose of this study is to investigate whether patients with hypogonadism undergoing primary TKA are at increased odds of (1) medical complications, (2) revisions, (3) in-hospital lengths of stay (LOSs), and (4) cost of care.

METHODS

A Humana patient population consisting of 8 million lives was retrospectively analyzed from 2007 to 2017 using International Classification of Disease, 9th Revision codes. Patients were filtered by male gender and patients with hypogonadism were matched to controls in a 1:4 ratio according to age and medical comorbidities. The query yielded 8393 patients with (n = 1681) and without (6712) hypogonadism undergoing primary TKA. Primary outcomes analyzed included medical complications, revision rates, in-hospital LOS, and cost of care. Logistic regression analysis was used to calculate odds ratios (OR) of 90-day medical complications and 2-year revisions. Welch's t-test was used to test for significance in LOS and cost of care between cohorts. A P-value less than .05 was considered statistically significant.

RESULTS

Hypogonadal patients undergoing primary TKA were found to have increased incidence and odds (9.45% vs 4.67%; OR 2.12, P < .0001) of developing 90-day medical complications. Hypogonadal patients undergoing primary TKA were found to have a greater incidence and odds (3.99% vs 2.80%; OR 1.89, P < .0001) of 2-year revisions. Hypogonadal patients had a 6.11% longer LOS (3.47 vs 3.27 days, P = .02) compared to controls, and incurred greater 90-day costs ($15,564.31 vs $14,856.69, P = .018) compared to controls.

CONCLUSION

This analysis of over 1600 patients demonstrates that patients with hypogonadism undergoing primary TKA have greater odds of postoperative medical complications, revisions, increased LOS, and cost of care.

Hormônios, sexualidade e envelhecimento masculino: um estudo de imagens em websites

Este trabalho tem como foco a construção do declínio hormonal masculino relacionado ao envelhecimento, como parte de um processo mais geral de medicalização da sexualidade e envelhecimento masculinos. A fim de atingir esse objetivo, foram pesquisados 14 websites de laboratórios farmacêuticos que comercializam drogas para a saúde sexual masculina e sete websites de associações médico-científicas voltadas para a saúde sexual masculina. Utilizamos as imagens encontradas em tais sites como material de análise. A partir do que foi analisado, discutimos a existência de uma parceria entre as associações médico-científicas e a indústria farmacêutica, que tende a apresentar o envelhecimento masculino como um problema médico, promovendo a terapia de reposição hormonal (TRH) com testosterona como tratamento. Tal terapia é também apresentada como um meio para recuperar a felicidade, a produtividade, a ‘qualidade de vida’ e o bem-estar.

[Evaluation of testosterone levels through distinct analytic methods in healthy men]

Plasma testosterone concentrations are essential for the diagnosis of several causes of hypogonadism, including late-onset hypogonadism. Defining the normal range for testosterone concentrations poses certain difficulties due to the changes that occur with age and the variability of the different analytical methods used.

OBJECTIVES

To study normal ranges of testosterone in healthy young men and to compare the results of distinct analytical methods.

MATERIAL AND METHODS

We recruited 20 healthy men with a mean age of 24.5 years (standard deviation (SD): 5.04) and a mean body mass index (BMI) of 23.8% (SD: 3.3). Total testosterone (TT) was measured by immunochemiluminescence (ICLA) and free testosterone (FT) by radioimmunoassay (RIA). Calculated free testosterone (FTc) and bioavailable testosterone (BT) were calculated using Vermeulen's formula. Serum lutropin (LH), follitropin (FSH) and sex hormone binding globulin (SHBG) were measured by immunoradiometric assays (IRMA).

RESULTS

The mean concentrations were 20 nmol/l (SD: 4.96) for TT, 0.054 nmol/L (SD: 0.01) for FT, 0.3834 nmol/L (SD: 0.09) for FTc and 9.9 nmol/L (SD: 2.8) for BT. There was no correlation between testosterone measured by different methods other than an association between FT and FTc (r=0.662, p<0.003) and between FTc and BT (r=0.979, p<0.0001). An inverse correlation was found between BMI and TT concentrations (r: -0.52, p<0.017).

CONCLUSIONS

The normal range for testosterone in healthy young men should be established in each laboratory based on the analytical method used.