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Wang Y, Jiang R. Androgens and erectile dysfunction: from androgen deficiency to treatment. Sex Med Rev 2024; 12:458-468. [PMID: 38719619 DOI: 10.1093/sxmrev/qeae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Androgens play important roles in regulating the growth and development of the male reproductive system and maintaining libido and erectile function. The specific mechanisms by which androgen deficiency leads to erectile dysfunction (ED) are not yet fully understood. OBJECTIVES To understand the mechanisms and treatment of androgen deficiency-related ED. METHODS A literature search in the past 10 years was conducted in PubMed and Google Scholar to determine the effects of androgen deficiency on erectile function and the treatment of androgen deficiency. RESULTS Androgen deficiency can be caused by hypothalamic-pituitary lesions and injuries, testicular-related diseases and injuries, endocrine and metabolic disorders, the side effects of medication, and age. Androgen deficiency can lead to ED by inhibiting the NOS/NO/cGMP pathway (nitric oxide synthase/nitric oxide/cyclic guanosine monophosphate) and altering the expression of ion channel proteins, as well as by inducing oxidative stress, death, and fibrosis in penile corpus cavernosum cells. Testosterone replacement therapy is effective at improving the serum testosterone levels and erectile function in patients with androgen deficiency. For patients who need to maintain a low androgenic state, erectile function can be improved by lifestyle changes, treatment with phosphodiesterase type 5 inhibitors, low-intensity extracorporeal shock wave therapy, and stem cell therapy. CONCLUSIONS Androgen deficiency can affect the structure and function of the penile corpus cavernosum, leading to ED. Areas of further study include how androgen replacement therapy can improve erectile function and how to improve the maintenance of erectile function in patients with hypoandrogenic status.
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Affiliation(s)
- Yuan Wang
- Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Rui Jiang
- Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
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Zhang Y, Ma L, Dong S, Ding Q, Wang S, Wu Q, Ni P, Zhang H, Chen Y, Wu J, Wang X. TLR4 inhibition suppresses growth in oestrogen-induced prolactinoma models. Endocr Relat Cancer 2022; 29:703-716. [PMID: 36219868 DOI: 10.1530/erc-22-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Prolactinomas have harmful effects on human health. Bromocriptine is the only commercially available drug in China, but about 25% of prolactinoma patients do not respond to it in clinic, its pathogenesis remains unknown. Thus, its pathogenesis needs to be determined to develop new therapeutic methods for prolactinomas. The expression of ERβ, TLR4, and prolactin (PRL) in the pituitary gland of C57BL/6 mice and human prolactinoma specimen was examined by immunofluorescence or immunohistochemistry. The role of TLR4 in prolactinoma was determined using estradiol-induced models of C57BL/6 wild-type and TLR4-/- mice. MMQ cells were treated with estradiol, fulvestrant, and lipopolysaccharide (LPS) or transfected with TLR4 siRNA to study the expression of ERβ, TLR4, and PRL in these cells. Furthermore, the interaction between ERβ and TLR4 was investigated by immunoprecipitation analysis. The expression of PRL and TLR4 was co-located and increased in the pituitary gland of mice and human prolactinoma specimen compared to that in the control specimen. Meanwhile, TLR4 knockout or treatment with the TLR4 inhibitor TAK242 not only significantly inhibited tumor overgrowth but also decreased the expression of PRL in estradiol-treated mice through p38 MAPK pathway regulation. However, MMQ treated with estradiol and LPS enhanced PRL expression than treated with estradiol or LPS alone. Finally, ERβ or TLR4 inhibition prevented the estradiol-induced PRL increase by regulating the TLR4/p38 MAPK pathway in vitro. Estradiol promoted prolactinoma development by activating the TLR4/p38 MAPK pathway through ERβ, and TLR4 is a potential therapeutic target for prolactinoma treatment.
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Affiliation(s)
- Yu Zhang
- Department of Pharmacy, Tongren hospital affiliated to Wuhan University (The Third Hospital of Wuhan), Wuhan, China
- Department of Pharmacy, Pulmonary Hospital of Wuhan, Wuhan, China
- Faculty of Pharmacy, Hubei University of Chinese Medicine, Wuhan, China
| | - Li Ma
- Department of Pharmacy, Tongren hospital affiliated to Wuhan University (The Third Hospital of Wuhan), Wuhan, China
| | - Shuguang Dong
- Department of Cardiology, Tongren Hospital affiliated to Wuhan University (The Third Hospital of Wuhan), Wuhan, China
| | - Qiaoyan Ding
- Department of Pharmacy, Pulmonary Hospital of Wuhan, Wuhan, China
| | - Shuman Wang
- Department of Pharmacy, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine
| | - Qi Wu
- Department of Pharmacy, Tongren hospital affiliated to Wuhan University (The Third Hospital of Wuhan), Wuhan, China
| | - Ping Ni
- Faculty of Pharmacy, Hubei University of Chinese Medicine, Wuhan, China
| | - Hong Zhang
- Department of Pharmacy, Tongren hospital affiliated to Wuhan University (The Third Hospital of Wuhan), Wuhan, China
| | - Yonggang Chen
- Department of Pharmacy, Tongren hospital affiliated to Wuhan University (The Third Hospital of Wuhan), Wuhan, China
| | - Jinhu Wu
- Department of Pharmacy, Tongren hospital affiliated to Wuhan University (The Third Hospital of Wuhan), Wuhan, China
| | - Xiong Wang
- Department of Pharmacy, Tongren hospital affiliated to Wuhan University (The Third Hospital of Wuhan), Wuhan, China
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Hypogonadism in Male Patients with Pituitary Adenoma and Its Related Mechanism: A Review of Literature. Brain Sci 2022; 12:brainsci12060796. [PMID: 35741681 PMCID: PMC9221259 DOI: 10.3390/brainsci12060796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
Maintaining normal gonadal axis hormone levels is important for improving the condition of male patients with pituitary adenoma. The current literature is somewhat divided on the results of evaluations of gonadal axis function in male patients with pituitary adenoma before and after treatment, and the increasing demand for better quality of life has provided motivation for this research to continue. In this article, we summarize the feasibility of using testosterone as an indicator for assessing male function and discuss the changes reported in various studies for gonadal hormones before and after treatment in male patients with pituitary adenoma. It is important for clinicians to understand the advantages of each treatment option and the effectiveness of assessing gonadal function. The rationale behind the theory that pituitary adenomas affect gonadal function and the criteria for evaluating pituitary–gonadal axis hormones should be explored in more depth.
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Yilmaz MK, Sulu C, Ozkaya HM, Kadioglu A, Ortac M, Kadioglu P. Evaluation of sex hormone profile and semen parameters in acromegalic male patients. J Endocrinol Invest 2021; 44:2799-2808. [PMID: 34050506 DOI: 10.1007/s40618-021-01593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the changes in semen quality and bioavailable testosterone concentrations in acromegalic male patients according to their disease activity and compare them with patients with non-functional pituitary adenoma (NFA) and healthy controls (HC). METHODS Twenty-four acromegalic patients with active disease, 22 acromegalic patients in remission, 10 HCs, and 10 patients with NFA were included. RESULTS Total and calculated bioavailable testosterone concentrations were lower in patients with pituitary disease. Patients with acromegaly had more severely impaired total testosterone levels and semen parameters in comparison to HCs and patients with NFA. The degree of impairment was more prominent in acromegalic patients with active disease than acromegalic patients in remission. Acromegalic patients in remission had residual impairments in both semen quality and testosterone concentrations. Patients with NFA had the lowest concentrations of calculated bioavailable testosterone, followed by acromegalic patients with active disease and acromegalic patients in remission. Increasing growth hormone (GH) levels were found to be associated with both more severely impaired semen quality and androgen concentrations. CONCLUSION Growth hormone hypersecretion can disturb reproductive biology and thereof semen quality. The reduction in semen quality and androgen levels may not fully recover upon disease control. Clinicians should be aware of the increased risk of impaired semen parameters and reduced total/bioavailable levels in acromegalic patients, especially in the setting of active disease.
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Affiliation(s)
- M K Yilmaz
- Department of Internal Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - C Sulu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - H M Ozkaya
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - A Kadioglu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M Ortac
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - P Kadioglu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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Hormone-Dependent Tumors and Sexuality in the Neuro-Oncology of Women (N.O.W.): Women's Brain Tumors, Gaps in Sexuality Considerations, and a Need for Evidence-Based Guidelines. Curr Oncol Rep 2021; 23:127. [PMID: 34453233 DOI: 10.1007/s11912-021-01115-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW While females make up almost 60% of all brain and spinal cord tumors in adults, guidelines that address women's issues in neuro-oncology are lacking. This review sheds light on two common women's issues in neuro-oncology. RECENT FINDINGS Neuro-oncology providers are often faced with patient questions about fertility and pregnancy maintenance or prevention and typically respond with generic cancer chemotherapy recommendations, based on the paucity of evidence on the use of common neuro-oncology chemotherapies and pregnancy. While these remain important gap issues, there are several other poorly researched issues in the Neuro-Oncology of Women (N.O.W.) including recommendations around endogenous and iatrogenic hormone exposure and female sexuality in cancer. As a significant percentage of cancers are hormone-dependent, it is important to understand how changes in hormone levels impact tumor biology over the course of a woman's lifespan. Furthermore, greater attention should be given to the impact of tumors and tumor treatments on female sexuality. This article is intended to serve as an introduction to these two specific subjects within the vast expanse of N.O.W. subject matter.
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Baydar AT, Ozercan AY, Divanlioglu D, Daglar Z, Balci M, Tuncel A. The Impact of Minimally Invasive Pituitary Surgery on Male and Female Sexual Dysfunction in Patients with Pituitary Adenoma. Urol Int 2021; 105:956-962. [PMID: 34247179 DOI: 10.1159/000517289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/03/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In the present study, we prospectively investigated the impact of endoscopic transnasal trans-sphenoidal surgery (ETTS) on sexual function in male and female patients with pituitary adenoma. METHODS The study included a total of 40 consecutive patients (male, n = 28 and female, n = 12) aged 22-65 years, who underwent ETTS for pituitary adenoma in our center between March 2019 and August 2019. Twenty-seven (67.5%) and 13 (32.5%) patients had functioning and nonfunctioning pituitary adenomas, respectively. Routine preoperative hormone levels were obtained in every patient. The tests were repeated at the postoperative third month. Preoperatively and at the postoperative third month, the 5-item version of the International Index of Erectile Function and the Female Sexual Function Index (FSFI) was used in male and female patients, respectively. RESULTS Before surgery, 24 (85.7%) men had erectile dysfunction (ED), and 10 (83%) women had female sexual dysfunction. After surgery, all the patients' abnormal hormone parameters improved. All the male patients' ED degrees were positively affected by surgery. In women, the FSFI was significantly better than in the preoperative period. DISCUSSION/CONCLUSION Our results showed that both males and females with pituitary adenomas benefitted from minimally invasive pituitary surgery in terms of a high-remission rate and improvement in sexual dysfunction.
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Affiliation(s)
- Aydin Talat Baydar
- Department of Neurosurgery, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Ali Yasin Ozercan
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Denizhan Divanlioglu
- Department of Neurosurgery, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Zeynep Daglar
- Department of Neurosurgery, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Melih Balci
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Altug Tuncel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
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Fan Y, Li Y, Li Y, Feng S, Bao X, Feng M, Wang R. Development and assessment of machine learning algorithms for predicting remission after transsphenoidal surgery among patients with acromegaly. Endocrine 2020; 67:412-422. [PMID: 31673954 DOI: 10.1007/s12020-019-02121-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/21/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Preoperative prediction of transsphenoidal surgical (TSS) response is important for determining individual treatment strategies for acromegaly. There is currently no accurate predictive model for TSS response for acromegaly. The current study sought to develop and validate machine learning (ML)-based models for preoperative prediction of TSS response for acromegaly. METHODS Six hundred sixty-eight patients with acromegaly were enrolled and divided into training (n = 534) and text datasets (n = 134) in this retrospective, data mining and ML study. The forward search algorithm was used to select features, and six ML algorithms were applied to construct TSS response prediction models. The performance of these ML models was validated using receiver operating characteristics analysis. Model calibration, discrimination ability, and clinical usefulness were also assessed. RESULTS Three hundred forty-nine (52.2%) patients achieved postoperative remission criteria and exhibited good TSS response. A univariate analysis was conducted and eight features, including age, hypertension, ophthalmic disorders, GH, IGF-1, nadir GH, maximal tumor diameter, and Knosp grade, were significantly associated with the TSS response in patients with acromegaly. After feature selection, the gradient boosting decision tree (GBDT), which was constructed with the eight significant features showed the best favorable discriminatory ability both the training (AUC = 0.8555) and validation (AUC = 0.8178) cohorts. The GBDT model showed good discrimination ability and calibration, with the highest levels of accuracy and specificity, and provided better estimates of TTS responses of patients with acromegaly compared with using only the Knosp grade. Decision curve analysis confirmed that the model was clinically useful. CONCLUSIONS ML-based models could aid neurosurgeons in the preoperative prediction of TTS response for patients with acromegaly, and could contribute to determining individual treatment strategies.
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Affiliation(s)
- Yanghua Fan
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, 100730, Beijing, China
| | | | - Yichao Li
- DHC Software Co. Ltd, Beijing, China
| | - Shanshan Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, 100730, Beijing, China
| | - Xinjie Bao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, 100730, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, 100730, Beijing, China.
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, 100730, Beijing, China.
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Fan Y, Liu Z, Hou B, Li L, Liu X, Liu Z, Wang R, Lin Y, Feng F, Tian J, Feng M. Development and validation of an MRI-based radiomic signature for the preoperative prediction of treatment response in patients with invasive functional pituitary adenoma. Eur J Radiol 2019; 121:108647. [DOI: 10.1016/j.ejrad.2019.108647] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/09/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023]
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