RESUMO
BACKGROUND: Male infertility is responsible for 35% of infertile couples. AIM: To investigate the causes of male infertility and the relative importance of endocrine factors. PATIENTS AND METHODS: Patients referred to an andrology clinic due to an abnormal spermiogram were studied. A testicular examination, spermiogram and determination of FSH, LH, testosterone and prolactin were done to all. Testicular biopsy was done to patients with severe oligospermia or azoospermia. Causes of infertility were defined and classified as pretesticular, testicular, posttesticular or unclassified. RESULTS: Two hundred fifty seven males were studied. In 3.5% of them, the cause of infertility was defined as pretesticular (that included hypothalamic and pituitary endocrine causes), in 66.9% it was classified as testicular, in 15.6% as posttesticular and in 14%, as unclassified. Thirty percent of infertility cases were idiopathic, 17.9% were associated to varicocele, 12.8% were associated to cryptorchidism, 8.9% to Klinefelter syndrome and 6.6% to exposure to toxic substances. In 50% of patients with cryptorchidism, this abnormality was found during the specialized andrological examination and referrals for surgical correction were made late. Two thirds of patients with Klinefelter syndrome were hypoandrogenic. CONCLUSIONS: Causes for male infertility should be investigated and diagnosed accurately. Primary hypoandrogenic testicular failures must be treated with hormone replacement therapy.
Assuntos
Doenças do Sistema Endócrino/complicações , Infertilidade Masculina/etiologia , Adolescente , Adulto , Hormônio Foliculoestimulante/sangue , Humanos , Infertilidade Masculina/sangue , Hormônio Luteinizante/sangue , Masculino , Pessoa de Meia-Idade , Prolactina/sangue , Doenças Testiculares/complicações , Testosterona/sangueRESUMO
In previous reports we have demonstrated high plasma levels of sex hormone-binding globulin (SHBG) in asymptomatic alcoholic men. In the present work the physicochemical properties of SHBG from plasma of noncirrhotic alcoholic patients have been further compared with SHBG of control subjects. Steroid binding to SHBG was similar for the two groups: alcoholic men, K(d) of 0.62 +/- 0.07 nM and control individuals, K(d) of 0.70 +/- 0.10 nM. The structure of oligosaccharides attached to SHBG from controls and alcoholic men were determined by using serial chromatography. Our data indicated that 7% of SHBG of control individuals was not retarded by the Con-A column, whereas approximately 30% of SHBG of alcoholic men eluted in the void volume of Con A. Approximately 46% of SHBG of alcoholics applied to Con A, possessed biantennary complex oligosaccharides, as indicated by the fact that it could be eluted with methyl-alpha-D-glucopyranoside and by its retention on wheat germ agglutinin; in contrast, when SHBG from control men was analyzed, approximately 51% was eluted with methyl-alpha-D-glucopyranoside. Approximately 9% of the biantennary complex oligosaccharides on SHBG of control men and none of those on SHBG from alcoholic men were fucosylated on the chitobiose core, as determined by chromatography on Lenn culinaris lectin. Galactosylated oligosaccharides were also present on the SHBG fraction as indicated by its interaction with Ricinus communis-I. Approximately 24% of SHBG of alcoholic men and 39% of those on SHBG from control individuals applied to Con-A were retained and could be eluted with methyl-alpha-D-mannopyranoside. Evidence based on the binding on mannoside-eluted SHBG to Con-A, wheat germ agglutinin, and R. communis-I indicated that at least the SHBG in this fraction, from alcoholics or controls, contained two glycosylation sites and that the sites were differentially glycosylated.
Assuntos
Oligossacarídeos/química , Globulina de Ligação a Hormônio Sexual/química , Globulina de Ligação a Hormônio Sexual/metabolismo , Adulto , Fracionamento Químico , Cromatografia de Afinidade , Cromatografia em Agarose , Concanavalina A/metabolismo , Di-Hidrotestosterona/metabolismo , Relação Dose-Resposta a Droga , Humanos , Hepatopatias Alcoólicas/metabolismo , Masculino , Pessoa de Meia-Idade , Ligação Proteica , TrítioRESUMO
Excessive ethanol ingestion induces hypoandrogenism in male subjects. To confirm its presence and to study its relationship with the degree of liver damage and alcohol abstinence, plasma sex hormones were measured in alcoholic patients without liver failure, after two different abstinence periods. Patients were 30 male chronic alcoholics admitted to the Alcoholism Ward for treatment of their addiction. On admission, we measured: testosterone (T), estradiol (E), follicle stimulating hormone (FSH), luteinizing hormone (LH) and sex-hormone binding globulin (SHBG). A liver biopsy was also performed. These measurements were repeated at discharge and were also done in 15 normal volunteers. On admission (mean abstinence 1.9 +/- 1.7 days) total T was similar to controls, FSH was lower (p < 0.02) and high levels of SHBG were found (3.5 fold increase, as compared to controls). Histologically, 9 patients had normal liver; 14 had moderate alterations and 7 showed marked alterations. Hormonal values were not different in these 3 groups. At discharge, 11.1 +/- 4.7 days after admission, T, E and FSH did not show significant changes but LH decreased (8.2 +/- 5.2 mIU/ml vs 12.9 +/- 4.1, p < 0.001); SHBG also decreased (65.4 +/- 21.6 nmol/l vs 117.2 +/- 33.3, p < 0.001) to values that still were twice those of controls. It is concluded that alcoholic patients without clinical signs of liver failure have normal plasma testosterone levels, irrespective of their histologic liver alterations and high plasma SHBG levels that decreased significantly after a short abstinence. The concomitant LH decrease suggests that hypoandrogenism is likely in these patients. Fast changes in SHBG levels rise the possibility that this protein is candidate marker of alcoholism.
Assuntos
Alcoolismo/sangue , Hormônios Esteroides Gonadais/sangue , Temperança , Adulto , Alcoolismo/patologia , Estudos de Casos e Controles , Humanos , Hepatopatias Alcoólicas/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
A 50 year-old male with diffuse hyperthyroid goiter treated with I131 who develops a papillary carcinoma is presented. After thyroid resection, substitution therapy with thyroid hormone (levothyroxine) was started, and a selective malabsorption for this hormone was verified.
Assuntos
Carcinoma Papilar/etiologia , Doença de Graves/tratamento farmacológico , Radioisótopos do Iodo/uso terapêutico , Neoplasias da Glândula Tireoide/etiologia , Tiroxina/farmacologia , Carcinoma Papilar/terapia , Doença de Graves/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/radioterapia , Tiroxina/sangue , Tri-Iodotironina/sangueRESUMO
The autoimmune polyglandular syndrome is characterized by the association of 2 or more endocrine disorders of autoimmune origin which may coexist with autoimmune disorders in other organs. Roughly 25% of patients with an autoimmune endocrinopathy show evidence of autoimmune disease elsewhere. We report 21 patients with autoimmune polyglandular syndrome classified according to Neufeld.
Assuntos
Doenças Autoimunes/complicações , Doenças do Sistema Endócrino/complicações , Adulto , Idoso , Autoanticorpos/análise , Doenças Autoimunes/classificação , Doenças Autoimunes/imunologia , Doenças do Sistema Endócrino/classificação , Doenças do Sistema Endócrino/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SíndromeRESUMO
We analyzed the clinical and echocardiographic features of 24 patients with infective endocarditis followed for a mean of 20.2 month (range 3-84) after discharge. Mean age was 38 years, male to female ratio was 2:1 and 87% of cases had a subacute clinical course; 17% of patients had late prosthetic endocarditis. Positive blood cultures were obtained in only 50% of patients. Vegetations were detected by echocardiography in 88%, 66% of them located at the aortic valve. Heart failure (62%) was the main complication, leading to valve replacement in 4 patients. Four patients died during follow up, 3 males due to heart failure and a female from systemic emboli. Twenty patients survive at the end of follow up (84%), 50% of them in FC I or II, 40% in FC III or IV (2 lost to follow up). Eleven patients had a late echocardiogram at a mean of 12 months after discharge: 6 of them showed persistence of vegetations (55%).