Prevalence of Endocrine and Metabolic Disorders in Subject with Erectile

Dysfunction : A Comparative Study

Elisa Maseroli MD, Giovanni Corona MD, Giulia Rastrelli, MD, PhD, Francesco Lotti, MD, Sarah

Cipriani, MD, Gianni Forti, MD, Edoardo Mannucci, MD and Mario Maggi MD

J Sex Med 2015; 12: 956-965

Introduction

• Sexual activity complex array of behaviours sexual communication language Hormone

• Message from Gland Blood stream Recipient targets.

• Impaired Hormonal activity Endocrine Disorders Sexual Dysfunction

• Hormonal changes determining/consequence of Erectile Dysfuction (ED) often bidirectional interconnection

• ED Highest incident of endocrine disorders in US (No accurate estimates)

• El Sakka et al. 1.248 patients with ED 25% with endocrine disorders

• Most frequent endocrinopaties: a. Hypogonadism (15%)

10-30% (varying on diagnosis cutoff value)

Screening in ED subject and Role of Testosterone suplementation therapy ?????

b. Hyperprolactinemia (13,7%)13% (mild)- < 1% (severe)

c. Hypothyroidism6% of 600 men with ED unsuspected hypothyroidism

• Common Metabolic Disorders:Type 2 DM (T2DM) + ObesityCV risk ED

Aim

• To overcome lack of information in current literature by comparing prevalence of several endocrinopaties in the same geographic area.

Material & Methods

• Subject : 1st Group European Male Aging Study, Florence, Italy (EMAS Cohort, n= 202) age 40-79 yearsExclusion criteria: ED, low libido, or decrease in morning erection using EMAS Questionnaire2nd Group outpatient attending andrology and sexual medicine clinic for the first time for ED ( UNIFI n= 3.847) age 40-79years, University of Florence, Italy

Demographical and clinical characteristic of sample

Statistical Analysis: • X2- test prevalence EMAS vs UNIFI• Hosmer-Lemeshow multivariate

analysis (goodness of fit of the model) Binary logistic regression

• Each analysis : adjusted for age & confounding factors interfereing with each endocrine disorders

Result

Prevalence (%) of endocrine and metabolic abnormalities in EMAS and UNIFI

* P < 0.05** P < 0.001

• HypogonadismPrimary & Secondary (total T< 10.5 nmol/L, LH > 9.4 U/L)

Compensated (total T ≥ 10.5 nmol/L, LH >9.4 U/L)• Hypo & Hyperthyroidism

Overt Hypothyroidism ( TSH > 5.5 mU/L, FT4 < 11.5 pmol/L)Hyperthyroidism (TSH < 0.35mU/L, FT4 > 23pmol/L)Subclinical hyperthyroidism (TSH < 0.35mU/L, N FT4 )Subclinical hypothyroidism (TSH < 5.5-10mU/L, N FT4)

• Hypo & HyperprolaktinemiaHyperprolactinemia mild (PRL >420mU/L or > 20ng/mL), severe (PRL > 735 mU/L or > 35ng/mL)Hypoprolactinemia (PRL < 113 mU/L or > 5ng/mL)

• Metabolic DisordersWaist circumference (≥ 102 cm) Impaired Fasting Glucose (IFG) (>100mg/dl)

Age Adjusted odd ratio for endocrine and metabolic abnormalities in EMAS and UNIFI

Discussion

• Subject with ED represent population steeped in metabolic disorders (Central obesity, IFG and T2DM) associated with hypogonadism

• Diabetes increased 3x of developing ED (35-90% ED T2DM), less responsive to 5 PDEi

• Pathogenesis of T2DM associated ED peripheral neuropathy & vasculopathy resulting cavernosal vasodilatory impairment, NO bioavailability

• Alteration of CV as sign of myocardial ischemia.• T2DM HT & Hyperlipidemia ED

• T2DM represent most important metabolic/endocrine motivation for ED consultation

• IFG associated with impairment of intercourse frequency, spontaneous and sex related erection and with decrease of flaccid and dynamic penile Doppler US present of atherosclerosis of penile blood vessels

• Obesity (Central Obesity) ED (UNIFI Cohort)Waist circumference>BMI for predictor of CV diseaseDiet induced viscral fat accumulation animal model nonalcoholic steatohepatitis (NASH) TNF-α activation ED

• Secondary hypogonadism prevalence in UNIFI increased metabolism disturbances

• T control several aspect of male sexual response deficiency sexual dysfunction (ED)

• Hyperprolactinemia associated with ED through PRL-induced inhibitory effect on LH secretion (under debate)

Conclusion

• T2DM, IFG, central obesity, secondary hipogonadism, and hypoprolactinemia more frequent in subject consulting for ED than in general population of the same geographic area

• Endocrine plays role in determining consultation for ED

• Clear causal relationship can’t be drawn in such study.

Critical Appraisal• Patients: EMAS (n= 202) and UNIFI (n=

3,847) • Intervention: no • Comparison:Endocrine and metabolic

disorders in subject with erectile dysfunction in EMAS and UNIFI

• Outcome(s): T2DM, IFG, central obesity, secondary hipogonadism, and hypoprolactinemia more frequent in subject consulting for ED than in general population

• V ( valid ) : Are the result of the study valid ?

The answer : Yes (see the method)• I ( Important ) : Are the valid result

of this study important ? The answer : Yes (see the method)• A ( Applicable ) : Can you apply this

valid, important evidence about this study for your patients ?

The answer : No

THANK YOU