Partial androgen deficiency syndrome in middle-aged and elderly men
Introduction
Introduction to partial androgen deficiency syndrome in middle-aged and elderly men The term menical menopausal syndrome (maleclimatericsyndrome) was first proposed by Werner in 1939. Later, based on the analysis of 273 patients over 50 years old, the clinical manifestations of the disease were: neurological disorders, depression, memory loss, Inattention, fatigue, insomnia, hot flashes, sweating, and decreased sexual function. Synonyms include menopause (menemenopause), male menopause (maleclimateric) and penpenuse (penopause). basic knowledge The proportion of sickness: 0.01% Susceptible people: seen in men Mode of infection: non-infectious Complications: coronary heart disease, benign prostatic hyperplasia, benign prostatic hyperplasia, benign prostatic hyperplasia, gastric cancer
Cause
The etiology of partial androgen deficiency syndrome in middle-aged and elderly men
(1) Causes of the disease
Testosterone is secreted by leydig cells in the testis, which is affected by the stimulation of LH secretion from the pituitary gland. The testosterone in combination with free testosterone and albumin in vivo.
Healthy men begin to decline in serum total testosterone and free testosterone levels from 50 to 59 years of age. Generally, free testosterone decreases by 1.2% per year, and albumin-bound testosterone decreases by 1.0% per year. Reasons:
1 With the increase of age, the total number of Leydig cells decreased, and the maximum secretion rate of testosterone decreased;
2 hypothalamic pituitary axis changes, LH pulsed release decreased, activity decreased, testicular interstitial cells did not respond;
3 Certain chronic diseases contribute to a decrease in serum testosterone levels.
Menopause is different from that of women. First, not all men have menopause. Secondly, there is no exact start time. Secondly, the performance is very different. The symptoms and signs of menopause include benign prostatic hyperplasia, sexual dysfunction, fatigue, emotional changes, and mammary gland development. And mild feminization, in addition, free testosterone plays an important role in the maintenance of bone mineral density. Therefore, elderly males may have adverse effects on bone density, muscle adipose tissue and hematopoietic function due to the lack of androgen.
(two) pathogenesis
About 54% of the circulating (testosterone) T binds to albumin (Alb-T), but the binding is loose; about 44% binds to sex hormone binding globulin (SHBG), which is firmer; the remaining 2% is free (FT Alb-T is easily dissociated in the tissue capillary bed, releasing T to be utilized by tissues. Therefore, A1b-T and FT are collectively called bioavailable T (Bio-T), and the release of T has circadian rhythm. More, less midnight, but its circadian rhythm is far less obvious than cortisol.
The effects of aging on T secretion, despite contradictory reports, meta-analysis of 88 published literatures showed that age and T ranged from -0.68 to 0.68, moderately correlated, with large variations in T levels, some The serum T level of elderly men can reach the upper limit of the normal range of young men. However, by analyzing the secretion rhythm of serum total T by frequent blood sampling, it can be found that the circadian rhythm of the old man is lost, and there is no peak of morning secretion. Bio-T test proves Serum Bio-T levels in healthy men gradually decrease with age, serum SHBG levels increase with age, may be related to increased obesity and estrogen levels, and the Massachusetts Old Man Study (MASS) concludes that Each year, SHBG increases by 1.2%, FT decreases by 1.2%, A1b-T decreases by 1.0%, and total T decreases by 0.4%. The reason for the decrease in T secretion may be due to the decrease in the maximum secretion capacity of the cells or the decrease in the number of cells. The flow is reduced.
If age aging causes primary testicular dysfunction, serum LH levels will inevitably increase. Conversely, if LH levels rise, serum T levels will decrease. Even if serum T levels are still in the normal range, it is suggested that there is Radi. Cell function defects, no significant decrease in T level is the result of increased LH secretion compensation in pituitary gonadotropin cells. Most studies report that serum LH in older men is increased with age. It is found that older men's LH and FSH molecules are more acidic. It may be related to the different sialic acid contained in the molecule, suggesting that the physical and biological characteristics of LH in the elderly are different from those of young people. The LH and FSH of older men have reduced response to exogenous GnRH excitability. LH pulse analysis found that about 40% The elderly men showed no pulse, and the pulsed treatment with exogenous GnRH could induce LH pulse secretion. The serum FSH level also increased with age, although the degree of increase had large individual differences. The above facts indicate that ageing is accompanied by Hypothalamic-pituitary function changes, but the mechanism is unknown.
Prevention
Prevention of partial androgen deficiency syndrome in middle-aged and elderly men
Supplementation of testosterone can increase solid tissue other than fat, but testosterone preparation can promote prostate hyperplasia, which can promote the development of cancer, and should be used with caution.
Complication
Middle-aged and elderly men with partial androgen deficiency syndrome complications Complications, coronary heart disease, benign prostatic hyperplasia, benign prostatic hyperplasia, benign prostatic hyperplasia
1. There is a gender difference in the incidence of sex hormones and coronary heart disease. In general, the incidence rate of males is higher than that of females. The prevalence of premenopausal women is significantly lower than that of males. The incidence of postmenopausal women has increased dramatically. Similar to men, there are significant differences in sex hormone levels between men and women before and after menopause. Therefore, the incidence of coronary heart disease is closely related to changes in sex hormone levels in the body.
It has been reported in the literature to determine serum sex hormone levels in 59 male patients with coronary heart disease (mean 56.98 ± 9.83 years) and 27 healthy men (mean 53.3 ± 11.26 years), and to determine 57 postmenopausal women with coronary heart disease (63.6 ± 7.3 years) Serum sex hormone levels in 27 healthy women (60.6 ± 6.8 years), results:
1 male and female coronary heart disease group serum progesterone (P) increased;
2 The testosterone (T) of the female coronary heart disease group was significantly increased;
3 male coronary heart disease group E2 / P significantly decreased;
4 E2/P and E2/T were significantly lower in women with coronary heart disease (Table 1), suggesting that elevated progesterone levels and increased androgen levels in postmenopausal women are risk factors for coronary heart disease.
2. Sex hormones and benign prostatic hyperplasia Li Yueming et al. For 41 elderly patients with benign prostatic hyperplasia, the levels of testosterone (T), dihydrotestosterone (DHT) and estradiol (E2) in tissues were determined by radioimmunoassay. The comparison of sex hormone levels in prostate tissue of healthy young people (accidental death) showed that the levels of DHT and E2 in the prostate tissue of the elderly with benign prostatic hyperplasia were significantly higher than those of healthy young people, while the T content was significantly lower than that of the young group (Table 2). It suggests that DHT and E2 play a regulatory role in the development and progression of benign prostatic hyperplasia.
3. Sex hormones and aging Lu Shaozhong measured plasma E2 and T levels in 45 healthy elderly and 30 elderly patients with coronary heart disease, and measured plasma lipid peroxide (LPO). Results: E2 and E2/T ratio in males The coronary heart disease group was elevated, and the T value was decreased in both male and female elderly patients with coronary heart disease, while LPO was increased in the male and female elderly coronary heart disease group (Table 3), suggesting that the elderly had unstable arterial levels in the plasma sex hormones. At the same time as atherosclerosis, there is an increase in aging indicators.
4. Sex hormones and gastric cancer have been studied and observed, androgen inhibits the occurrence and growth of gastric cancer, while estrogen plays a promoting role. Inutsuka et al. measured serum testosterone levels in gastric cancer patients, both male and female patients (including early gastric cancer) before surgery. Decreased and gradually returned to normal after surgery; if relapsed, testosterone levels decreased again.
In addition, it has been confirmed that there are estrogen receptors in gastric cancer cells, Nishi et al. measured 52 cases of estrogen-positive 23 cases (44.2%) in gastric cancer tissues, and 7 cases (20.6%) of female climacteric patients in 34 cases, and the height was high. Malignant gastric cancer is common in young women, suggesting that female hormones are closely related to gastric cancer.
Symptom
Middle-aged and elderly men with partial androgen deficiency syndrome symptoms common symptoms libido fatigue tired forgetfulness inattention drowsiness weakness palpitations androgen dependence loss of appetite depression
Symptoms and signs of menopause include benign prostatic hyperplasia, sexual dysfunction, fatigue, clear blood changes, mammary gland development and mild feminization. In addition, free testosterone plays an important role in the maintenance of bone mineral density. All older men lack male sex hormones. It can adversely affect bone density, muscle, adipose tissue and hematopoietic function.
Other clinical manifestations that may be related to PADAM:
1 neurological and vasomotor symptoms: hot flashes, sweating, insomnia and nervousness;
2 emotional and cognitive symptoms: anxiety, lethargy, poor self-perception, lack of motivation, decreased brain power, recent memory loss, depression, lack of self-confidence and fear of no cause; 3 masculinization symptoms: physical and mental decline , muscle mass and muscle strength decline, sexual hair loss and abdominal obesity;
4 symptoms of sexual dysfunction: loss of libido, decreased sexual activity, ED, decreased quality of libido orgasm, ejaculation weakness and decreased semen volume.
Although the causal relationship between the above symptoms and testicular dysfunction remains controversial, different clinicians define the symptoms of PADAM in practice, but the consistent assessment of symptom evaluation is the first step in screening diagnosis.
Examine
Examination of partial androgen deficiency syndrome in middle-aged and elderly men
Serum total testosterone and free testosterone levels decreased.
According to the clinical symptoms, you can choose ECG, prostate B-ultrasound and bone density examination.
Diagnosis
Diagnosis and diagnosis of partial androgen deficiency syndrome in middle-aged and elderly men
The Bosphorus Psychology Department in Istanbul uses self-scores to quantify relevant symptoms, including:
1 physical symptoms: general weakness, insomnia, loss of appetite, bone and joint pain;
2 vasomotor symptoms: hot flashes, sweating, palpitations;
3 mental and psychological symptoms: forgetfulness, lack of concentration, fear, irritability, loss of interest in previously interested things;
4 symptoms of sexual dysfunction: loss of interest in sexual activity, indifferent to sexy things, spontaneous erection disappeared in the morning, sexual intercourse is unsuccessful, can not erect during sexual intercourse, according to the duration of these symptoms, the score is divided into 4 levels: always ( 3 points), often (2 points), sometimes (1 point), no (0 points), if the physical symptoms plus vasomotor symptoms total score 5, or mental and psychological symptoms total score 4, or sexual dysfunction A total symptom score of 8 may have the possibility of suffering from PADAM.
If the total score of the symptom score reaches the defined value, the subject is considered to be likely to have PADAM, and the second step of the diagnosis is to measure Bio-T. If the Bio-T value is lowered, the PADAM can be diagnosed and the Bio-T value is lowered. The definition may be influenced by factors such as race, region and measurement method. Therefore, the standard should be established. The standard of St. Louis University Medical Center is 70 ng/dl. Below this level, the Bio-T level is reduced. Once the PADAM diagnosis is made. That is, experimental testosterone supplementation should be performed.
