HORMONAL AND CLINICAL PROFILE OF HYPOGONADISM IN DIABETES PATIENTS

Abstract

Introduction: Hypogonadism in male is defined as a condition in which there is a clinical characterization of both sign and symptom and biochemical evidence of testosterone deficiency. Male hypogonadism is one kind of recognized medical condition in which these remains under diagnosed by clinicians. A clinical syndrome which consists of with or without signs and associated with biochemical evidence of testosterone deficiency in called Hypogonadism. Over two decades ago, association between the diabetes mellitus (DM) and hypogonadism came to limelight when a high prevalence of low testosterone levels was observed in men with diabetes. Many studies showed that in one‑third of diabetic men there are low free testosterone levels, which are independent of sex hormone‑binding globulin (SHBG). Due to deficiency of testosterone in men is associated with negative consequences. Many research showed that in DM patients there is increasing evidence of hypogonadism is a risk factor for coronary artery disease, the leading cause of mortality. Other adverse effects are also been reported associated with hypogonadism which included as poor quality of life, sexual dysfunction, increased fracture risk, increasing fat mass, cognitive decline, and mortality. Aim: The main aim of this study is to find out the type of hypogonadism as either hypogonadotropic or hypergonadotropic in DM patients. Material and methods: Total 70 patients were include in this study in which patients visiting out patients department (OPD) of medicine and in patients department (IPD). Individuals with chronic systemic illness, abuse drugs or alcohol and undergone cancer chemotherapy or radiotherapy were excluded in this study. Detailed history of the patients was taken from the patients like height, weight and arm span with general and systemic examination to rule out any systemic illness were noted. Estimation of hormonal levels was noted from all patients. Result: Total 80 DM male patients were included in this study. Out of 70 patients 49 (70%) were below 35 years old and remaining 21(30%) were above 36 years old. Out of 70 patients 55 had hypogonadotropic hypogonadism and 15 had hypergonadotropic hypogonadism in male respectively. Out of total patients 55 had hypogonadotropic hypogonadism. Most common etiology was idiopathic hypogonadotropic hypogonadism. Patient with bilateral anorchia or vanishing testis syndrome, two patients had kallmann syndrome, five of them had hypopituitarism and interestingly three patients had features of gigantism and hypogonadism. 15 patients had hypergonadotropic hypogonadism in which 11 had Klinefelter syndrome and 4 had Turner’s syndrome. Conclusion: The most common cause is Idiopathic hypogonadotropic hypogonadism is shown in male. Height, weight and Arm span varied significantly between Males of hypogonadotropic hypogonadism and hypergonadotropic hypogonadism. Maximum number of patients of DM in India, the incidence of hypogonadism is more in diabetic patients as compared to the general population. Hence, implementation of screening programs in diabetic patients is necessary to understand and detect individuals with low serum total testosterone at any early stage and to supplement testosterone accordingly.
 Keywords: diabetes mellitus, hypogonadism, testosterone, Hypogonadotropic hypogonadism