Hypogonadism Ups MetS Risk in Testicular Cancer Patients

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Hypogonadal testicular cancer survivors had 15 times higher odds of metabolic syndrome than their eugonadal counterparts.
Hypogonadal testicular cancer survivors had 15 times higher odds of metabolic syndrome than their eugonadal counterparts.

Hypogonadism in testicular cancer survivors (TCS) is associated with an increased likelihood of risk factors for cardiovascular disease and metabolic syndrome (MetS) compared with eugonadal TCS, researchers concluded in a recent report.

A team led by Aleksander Giwercman, MD, of Lund University, Malmö, Sweden, studied 92 TCS (mean age 31 years at diagnosis) with a mean 9.2 years of follow-up and 92 age-matched controls. The researchers analyzed blood samples for lipids, total testosterone, luteinizing hormone (LH), glucose, and insulin. The researchers defined hypogonadism as a total testosterone level less than 288 ng/dL and/or an LH level above 10 IU/L, or ongoing androgen replacement therapy.

Metabolic syndrome (MetS) was present in 15.2% of the TCS group — 36% among those with hypogonadism — and 9.8% of controls. Hypogonadal TCS had 4.4 times higher odds of MetS compared with controls and 15 times higher odds of MetS compared with TCS with normal testosterone levels in adjusted analyses, the investigators reported in Andrology (2017; published online ahead of print).

The investigators defined MetS according to criteria established by the 2005 National Cholesterol Education Program Adult Treatment Panel III. Patients had to meet 3 of the following criteria for a MetS diagnosis: systolic blood pressure (BP) 130 mm or higher and/or diastolic BPH 85 mm Hg or higher; fasting glucose 100 mg/dL or higher; high-density lipoprotein level below 40 mg/dL; and waist circumference 102 cm or higher.

Results also showed that the TCS group had significantly higher mean HbA1c levels (5.4% vs 5.3%) and waist measurements (95.7 vs 91 cm) than controls. In the TCS group, hypogonadal patients had significantly higher mean triglyceride levels (138 vs 100 mg/dL), insulin levels (9.44 vs 6.34 mIU/L), and insulin resistance (HOMA-IR 2.45 vs 1.46), and waist circumference (100 vs 92.9 cm) compared with eugonadal patients.

At the 2017 American Society of Clinical Oncology annual meeting in Chicago in June, researchers reported on a study of 491 TCS showing that a significantly higher proportion of hypogonadal than eugonadal men had erectile dysfunction (20% vs. 12%), hypertension (19% vs. 11%), and dyslipidemia (20% vs 6%).

References

1. Bogefors C, Isaksson S, Bobjer J, et al. Hypogonadism in testicular cancer patients is associated with risk factors of cardiovascular disease and the metabolic syndrome. Andrology 2017; published online ahead of print.

2. Zaid MIA, Menendez AG, Charif OE, et al. Adverse health outcomes in relationship to hypogonadism (HG) after platinum-based chemotherapy: A multicenter study of North American testicular cancer survivors (TCS). Presented at the 2017 American Society of Clinical Oncology annual meeting in Chicago, June 2-6. Abstract LBA10012.

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