Update: Hypogonadotropic Hypogonadism in Type 2 Diabetes and Obesity
Update: Hypogonadotropic Hypogonadism in Type 2 Diabetes and Obesity
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DOI：
10.1210/jc.2010-2724
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发表时间：
2011-09-01
影响因子：
5.8
通讯作者：
Dhindsa, Sandeep
中科院分区：
文献类型：
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作者：
Dandona, Paresh;Dhindsa, Sandeep
过去几年的研究清楚地表明，至少25%的2型糖尿病男性游离睾酮浓度低于正常水平，并伴有LH和FSH浓度过低。另有4%的患者睾酮浓度低于正常水平，黄体生成素和卵泡刺激素浓度升高。因此，内分泌学会现在建议对2型糖尿病患者进行常规睾酮检测。睾酮浓度过低与糖化血红蛋白或糖尿病病程无关，但与肥胖、c反应蛋白浓度过高和轻度贫血有关。此外，在两项早期研究中，这些男性的睾酮浓度低于正常水平与心血管事件和死亡风险增加2至3倍有关。对性腺功能低下的2型糖尿病患者进行睾酮治疗的短期研究表明，胰岛素敏感性增加，腰围减少。然而，关于睾酮替代对血糖控制和心血管危险因素（如胆固醇和c反应蛋白浓度）的影响的数据不一致。就性功能而言，睾酮治疗可增加性欲，但不能改善勃起功能障碍，因此可能需要磷酸二酯酶抑制剂。显然需要更长时间的试验来明确确定睾酮替代对2型糖尿病和低睾酮患者的益处和风险。[J] .中华内分泌杂志，2011,31(4):344 - 344。
Studies over the last few years have clearly established that at least 25% of men with type 2 diabetes have subnormal free testosterone concentrations in association with inappropriately low LH and FSH concentrations. Another 4% have subnormal testosterone concentrations with elevated LH and FSH concentrations. The Endocrine Society, therefore, now recommends the measurement of testosterone in patients with type 2 diabetes on a routine basis. The subnormal testosterone concentrations are not related to glycosylated hemoglobin or duration of diabetes, but are associated with obesity, very high C-reactive protein concentrations, and mild anemia. In addition, subnormal testosterone concentrations in these men are associated with a two to three times elevated risk of cardiovascular events and death in two early studies. Short-term studies of testosterone therapy in hypogonadal men with type 2 diabetes have demonstrated an increase in insulin sensitivity and a decrease in waist circumference. However, the data on the effect of testosterone replacement on glycemic control and cardiovascular risk factors such as cholesterol and C-reactive protein concentrations are inconsistent. As far as sexual function is concerned, testosterone treatment increases libido but does not improve erectile dysfunction and thus, phosphodiesterase inhibitors may be required. Trials of a longer duration are clearly required to definitively establish the benefits and risks of testosterone replacement in patients with type 2 diabetes and low testosterone. (J Clin Endocrinol Metab 96: 2643-2651, 2011)