Pub Date : 2006-08-01DOI: 10.1097/01.med.0000235321.01047.5d
M. Peakman, B. Roep
Purpose of reviewSince type 1 diabetes mellitus is a T lymphocyte-mediated disease, numerous T cell-centric strategies aimed at either interfering with pathogenic effector T cells, or promoting regulatory ones, are at the stage of planned clinical trials or beyond. The feasibility of measuring reductions in activity or number of pathogenic T cells and/or equivalent increases in regulatory cells is the focus of this review. Recent findingsThe design of surrogate T cell markers for trial monitoring has been facilitated by the recent deployment of new assay technologies, a greater knowledge of islet-specific T cell targets and a greater understanding of the T cell-dominated pathogenic process leading to islet destruction, as well as the regulatory pathways designed to prevent it. SummaryAdvances in technologies designed to measure the anticipated low frequency of autoreactive T cells, as well as recent discoveries in the field of regulatory T cells and the creation of clinical trial consortia, have set the stage for the implementation of large-scale clinical trials in type 1 diabetes in which the measurement of T cell reactivity is viewed as a key mechanistic outcome.
{"title":"Secondary measures of immunologic efficacy in clinical trials","authors":"M. Peakman, B. Roep","doi":"10.1097/01.med.0000235321.01047.5d","DOIUrl":"https://doi.org/10.1097/01.med.0000235321.01047.5d","url":null,"abstract":"Purpose of reviewSince type 1 diabetes mellitus is a T lymphocyte-mediated disease, numerous T cell-centric strategies aimed at either interfering with pathogenic effector T cells, or promoting regulatory ones, are at the stage of planned clinical trials or beyond. The feasibility of measuring reductions in activity or number of pathogenic T cells and/or equivalent increases in regulatory cells is the focus of this review. Recent findingsThe design of surrogate T cell markers for trial monitoring has been facilitated by the recent deployment of new assay technologies, a greater knowledge of islet-specific T cell targets and a greater understanding of the T cell-dominated pathogenic process leading to islet destruction, as well as the regulatory pathways designed to prevent it. SummaryAdvances in technologies designed to measure the anticipated low frequency of autoreactive T cells, as well as recent discoveries in the field of regulatory T cells and the creation of clinical trial consortia, have set the stage for the implementation of large-scale clinical trials in type 1 diabetes in which the measurement of T cell reactivity is viewed as a key mechanistic outcome.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"325–331"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000235321.01047.5d","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61655935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-08-01DOI: 10.1097/01.med.0000235326.31541.a5
D. Papadogias, P. Makras, I. Griniatsos, G. Kaltsas, A. Grossman
Purpose of reviewOur review will focus on gastroenteropancreatic neuroendocrine tumours, summarizing recent data on their diagnosis and management. Recent findingsHistopathological classification is currently essential not only in establishing the diagnosis of gastroenteropancreatic tumours but also guiding further management. The detection rate of all imaging modalities has greatly improved and, in particular, the introduction of radionuclide modalities has identified occult lesions and improved the staging of gastroenteropancreatic tumours. While somatostatin analogues successfully control the symptoms of functioning tumours and may frequently control their growth, radical tumour resection represents the only curative approach; it is also increasingly being used for palliation, even with advanced disease. The majority of gastroenteropancreatic tumours are well differentiated and slow-growing and are best treated with somatostatin analogues or α-interferon. Treatment with radiolabelled somatostatin analogues represents an alternative therapeutic modality for tumours exhibiting uptake on a diagnostic scan. Chemotherapy is reserved for poorly differentiated or progressive but well differentiated gastroenteropancreatic lesions. Novel individual therapies and new combinations of established therapies are evolving and undergoing clinical assessment. In all cases, a multidisciplinary approach is essential. SummarySuccessful treatment requires a multimodal approach aimed at symptomatic control and prevention of further tumour growth. Advances in modalities using radionuclides have been incorporated into the diagnosis, staging and therapy of gastroenteropancreatic neuroendocrine tumours.
{"title":"Advances in the detection and management of neuroendocrine (carcinoid and pancreatic islet cell) tumours","authors":"D. Papadogias, P. Makras, I. Griniatsos, G. Kaltsas, A. Grossman","doi":"10.1097/01.med.0000235326.31541.a5","DOIUrl":"https://doi.org/10.1097/01.med.0000235326.31541.a5","url":null,"abstract":"Purpose of reviewOur review will focus on gastroenteropancreatic neuroendocrine tumours, summarizing recent data on their diagnosis and management. Recent findingsHistopathological classification is currently essential not only in establishing the diagnosis of gastroenteropancreatic tumours but also guiding further management. The detection rate of all imaging modalities has greatly improved and, in particular, the introduction of radionuclide modalities has identified occult lesions and improved the staging of gastroenteropancreatic tumours. While somatostatin analogues successfully control the symptoms of functioning tumours and may frequently control their growth, radical tumour resection represents the only curative approach; it is also increasingly being used for palliation, even with advanced disease. The majority of gastroenteropancreatic tumours are well differentiated and slow-growing and are best treated with somatostatin analogues or α-interferon. Treatment with radiolabelled somatostatin analogues represents an alternative therapeutic modality for tumours exhibiting uptake on a diagnostic scan. Chemotherapy is reserved for poorly differentiated or progressive but well differentiated gastroenteropancreatic lesions. Novel individual therapies and new combinations of established therapies are evolving and undergoing clinical assessment. In all cases, a multidisciplinary approach is essential. SummarySuccessful treatment requires a multimodal approach aimed at symptomatic control and prevention of further tumour growth. Advances in modalities using radionuclides have been incorporated into the diagnosis, staging and therapy of gastroenteropancreatic neuroendocrine tumours.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"78 1","pages":"356–361"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000235326.31541.a5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61655521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-08-01DOI: 10.1097/01.med.0000235320.23917.c5
D. Gross, K. E. Earle, J. Bluestone, Q. Tang
Purpose of reviewThe discovery of a subpopulation of CD4+ T cells critical for the control of lethal lymphoproliferative and autoimmune disease in the early 1980s opened the door to a whole new realm of generating a tolerant immune system. These regulatory T cells develop in the thymus and can be induced under certain circumstances in the periphery. They express a unique constellation of cell-surface and lineage-specific markers, and exert potent suppressive effect on adaptive and innate immunity in vivo. Recent findingsRecent work has aimed to clarify the unique markers of regulatory T cells as well as the mechanisms by which they mediate their suppressive function in various disease settings such as autoimmunity, transplantation and infectious diseases. Here, we summarize the major findings in the field of regulatory T cells biology with emphasis on the past year's publications and conclude with a discussion on the role of regulatory T cells in type 1 autoimmune diabetes. SummaryAs regulatory T cells are a vital component to self tolerance, understanding their function will help to elucidate disease pathogenesis and to design novel therapeutic interventions to restore normal immune homeostasis in patients.
{"title":"Regulatory T cells and their role in type 1 diabetes","authors":"D. Gross, K. E. Earle, J. Bluestone, Q. Tang","doi":"10.1097/01.med.0000235320.23917.c5","DOIUrl":"https://doi.org/10.1097/01.med.0000235320.23917.c5","url":null,"abstract":"Purpose of reviewThe discovery of a subpopulation of CD4+ T cells critical for the control of lethal lymphoproliferative and autoimmune disease in the early 1980s opened the door to a whole new realm of generating a tolerant immune system. These regulatory T cells develop in the thymus and can be induced under certain circumstances in the periphery. They express a unique constellation of cell-surface and lineage-specific markers, and exert potent suppressive effect on adaptive and innate immunity in vivo. Recent findingsRecent work has aimed to clarify the unique markers of regulatory T cells as well as the mechanisms by which they mediate their suppressive function in various disease settings such as autoimmunity, transplantation and infectious diseases. Here, we summarize the major findings in the field of regulatory T cells biology with emphasis on the past year's publications and conclude with a discussion on the role of regulatory T cells in type 1 autoimmune diabetes. SummaryAs regulatory T cells are a vital component to self tolerance, understanding their function will help to elucidate disease pathogenesis and to design novel therapeutic interventions to restore normal immune homeostasis in patients.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"319–324"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000235320.23917.c5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61655886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-08-01DOI: 10.1097/01.med.0000235325.54411.85
W. Couldwell, M. Weiss
Purpose of reviewRathke's cleft cysts arise from embryonic remnants of Rathke's cleft. The purpose of this paper is to review the current knowledge pertaining to Rathke's cleft cysts. Recent studies regarding the management of Rathke's cleft cysts are also discussed. Recent findingsRathke's cleft cysts generally exhibit a benign clinical course. Magnetic resonance imaging is the diagnostic imaging study of choice. Although the most consistent sign to differentiate Rathke's cleft cysts is the lack of enhancement of the cyst wall on contrast-enhanced magnetic resonance images, the presence of an intracystic nodule of low signal intensity on T2-weighted images and possibly high signal intensity on T1-weighted images is highly characteristic of Rathke's cleft cysts. Surgical management is the treatment for symptomatic Rathke's cleft cysts, although asymptomatic lesions may be followed conservatively. Drainage of the cyst contents is the primary goal of surgery; aggressive total resection of the cyst wall, however, may be associated with greater endocrine morbidity. Recurrence may be more common than previously noted when a longer follow-up period is observed. SummaryIncidental Rathke's cleft cysts may be followed with serial imaging. Symptomatic Rathke's cleft cysts are best removed via the transsphenoidal route. Extended postoperative follow-up is indicated in all patients.
{"title":"Surgical management of Rathke's cleft cysts","authors":"W. Couldwell, M. Weiss","doi":"10.1097/01.med.0000235325.54411.85","DOIUrl":"https://doi.org/10.1097/01.med.0000235325.54411.85","url":null,"abstract":"Purpose of reviewRathke's cleft cysts arise from embryonic remnants of Rathke's cleft. The purpose of this paper is to review the current knowledge pertaining to Rathke's cleft cysts. Recent studies regarding the management of Rathke's cleft cysts are also discussed. Recent findingsRathke's cleft cysts generally exhibit a benign clinical course. Magnetic resonance imaging is the diagnostic imaging study of choice. Although the most consistent sign to differentiate Rathke's cleft cysts is the lack of enhancement of the cyst wall on contrast-enhanced magnetic resonance images, the presence of an intracystic nodule of low signal intensity on T2-weighted images and possibly high signal intensity on T1-weighted images is highly characteristic of Rathke's cleft cysts. Surgical management is the treatment for symptomatic Rathke's cleft cysts, although asymptomatic lesions may be followed conservatively. Drainage of the cyst contents is the primary goal of surgery; aggressive total resection of the cyst wall, however, may be associated with greater endocrine morbidity. Recurrence may be more common than previously noted when a longer follow-up period is observed. SummaryIncidental Rathke's cleft cysts may be followed with serial imaging. Symptomatic Rathke's cleft cysts are best removed via the transsphenoidal route. Extended postoperative follow-up is indicated in all patients.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"351–355"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000235325.54411.85","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61655510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-08-01DOI: 10.1097/01.med.0000235327.39164.27
G. Merriam, Felicie G. Wyatt
Purpose of reviewTo review recent developments in the clinical consequences, evaluation, and treatment of growth hormone deficiency in adults after completion of statural growth. Recent findingsAlthough pituitary adenomas and craniopharyngiomas remain the most common causes of adult growth hormone deficiency, other etiologies are now recognized, particularly head trauma of even moderate severity. Provocative growth hormone testing is important in the diagnostic process, but should only be conducted in the appropriate clinical context. Adult growth hormone deficiency is associated with subtle increases in cortisol synthesis, which may account for some of its features. Patients often have reduced quality of life scores and some impairment in cognitive performance, both improved by replacement therapy. A dosing strategy starting with a low dose, independent of weight, gradually titrated upwards is as effective as traditional weight-based dosing. Although growth hormone should not be given to patients with active malignancies, there is no increased risk of recurrent or new cancers with adult growth hormone replacement. Longer-acting growth hormone preparations are under development. SummaryDespite a solid base of evidence, the high cost of growth hormone replacement causes concerns about its cost-effectiveness. Objective validated measures to assess this in adult growth hormone deficiency are lacking, but a consensus as to its appropriate use is emerging.
{"title":"Diagnosis and treatment of growth hormone deficiency in adults: current perspectives","authors":"G. Merriam, Felicie G. Wyatt","doi":"10.1097/01.med.0000235327.39164.27","DOIUrl":"https://doi.org/10.1097/01.med.0000235327.39164.27","url":null,"abstract":"Purpose of reviewTo review recent developments in the clinical consequences, evaluation, and treatment of growth hormone deficiency in adults after completion of statural growth. Recent findingsAlthough pituitary adenomas and craniopharyngiomas remain the most common causes of adult growth hormone deficiency, other etiologies are now recognized, particularly head trauma of even moderate severity. Provocative growth hormone testing is important in the diagnostic process, but should only be conducted in the appropriate clinical context. Adult growth hormone deficiency is associated with subtle increases in cortisol synthesis, which may account for some of its features. Patients often have reduced quality of life scores and some impairment in cognitive performance, both improved by replacement therapy. A dosing strategy starting with a low dose, independent of weight, gradually titrated upwards is as effective as traditional weight-based dosing. Although growth hormone should not be given to patients with active malignancies, there is no increased risk of recurrent or new cancers with adult growth hormone replacement. Longer-acting growth hormone preparations are under development. SummaryDespite a solid base of evidence, the high cost of growth hormone replacement causes concerns about its cost-effectiveness. Objective validated measures to assess this in adult growth hormone deficiency are lacking, but a consensus as to its appropriate use is emerging.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"362–368"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000235327.39164.27","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61655564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-08-01DOI: 10.1097/01.med.0000235323.08670.4f
A. Wiseman, P. Gottlieb
Purpose of reviewPatients with diabetes are not infrequently faced with considering the possibility of organ transplantation, both as a therapy to manage diabetes itself as well as a therapy to manage complications of diabetes. Healthcare providers must be aware of the outcomes and advances in kidney, pancreas and islet transplantation in order to effectively advise and guide patients through the process of transplant evaluation. Recent findingsRecently, it has become clear that an aggressive approach to kidney transplantation should be taken in patients with diabetes with kidney failure, including early referral and consideration of ‘expanded donor criteria’ donor kidneys. Pancreas transplantation has become increasingly successful and may offer a subset of these patients a survival advantage, but the timing of pancreas transplantation remains in question. The field of islet transplantation continues to evolve, and offers significant benefits of resolution of hypoglycemia unawareness and improved glycemic control with less procedural complications. SummaryKidney transplantation must be recognized by all healthcare providers as the treatment of choice in individuals with diabetes and renal failure. Advances in both pancreas and islet transplantation now demonstrate significant benefits for specific populations, and can be considered for subsets of patients with type 1 diabetes.
{"title":"Transplant therapies for diabetes: a review of outcomes and indications for kidney, pancreas and islet transplantation","authors":"A. Wiseman, P. Gottlieb","doi":"10.1097/01.med.0000235323.08670.4f","DOIUrl":"https://doi.org/10.1097/01.med.0000235323.08670.4f","url":null,"abstract":"Purpose of reviewPatients with diabetes are not infrequently faced with considering the possibility of organ transplantation, both as a therapy to manage diabetes itself as well as a therapy to manage complications of diabetes. Healthcare providers must be aware of the outcomes and advances in kidney, pancreas and islet transplantation in order to effectively advise and guide patients through the process of transplant evaluation. Recent findingsRecently, it has become clear that an aggressive approach to kidney transplantation should be taken in patients with diabetes with kidney failure, including early referral and consideration of ‘expanded donor criteria’ donor kidneys. Pancreas transplantation has become increasingly successful and may offer a subset of these patients a survival advantage, but the timing of pancreas transplantation remains in question. The field of islet transplantation continues to evolve, and offers significant benefits of resolution of hypoglycemia unawareness and improved glycemic control with less procedural complications. SummaryKidney transplantation must be recognized by all healthcare providers as the treatment of choice in individuals with diabetes and renal failure. Advances in both pancreas and islet transplantation now demonstrate significant benefits for specific populations, and can be considered for subsets of patients with type 1 diabetes.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"22 1","pages":"338–343"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000235323.08670.4f","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61655953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-06-01DOI: 10.1097/01.med.0000224805.31695.6a
G. T’Sjoen, J. Kaufman
Purpose of reviewNumerous publications of recent years have focused on androgen decline in elderly men. Diagnosis, clinical significance and treatment remain highly controversial issues. The present review aims at a critical overview of the topic with particular attention on recent studies and informative reviews. Recent findingsIt is now well established that aging in men is accompanied by a progressive decline of testosterone levels. Associations with clinical signs and symptoms are usually weak and most study areas have been on bone metabolism, body composition, sexual function, cardiovascular risk factors, mood, depression and cognitive function. The main focus of intervention studies has been on body composition, bone metabolism, sexual function and indices related to quality of life, besides safety parameters. These studies have included a limited number of men, are of relatively short duration, and measure intermediary clinical endpoints. SummaryTo date, intervention studies have included too few partially androgen deficient patients and were of too short duration to provide reliable data on long-term risks versus benefits of androgen replacement therapy in elderly men. In this context, treatment should be reserved for elderly men with clear hypogonadism.
{"title":"Androgen deficiency in aging men","authors":"G. T’Sjoen, J. Kaufman","doi":"10.1097/01.med.0000224805.31695.6a","DOIUrl":"https://doi.org/10.1097/01.med.0000224805.31695.6a","url":null,"abstract":"Purpose of reviewNumerous publications of recent years have focused on androgen decline in elderly men. Diagnosis, clinical significance and treatment remain highly controversial issues. The present review aims at a critical overview of the topic with particular attention on recent studies and informative reviews. Recent findingsIt is now well established that aging in men is accompanied by a progressive decline of testosterone levels. Associations with clinical signs and symptoms are usually weak and most study areas have been on bone metabolism, body composition, sexual function, cardiovascular risk factors, mood, depression and cognitive function. The main focus of intervention studies has been on body composition, bone metabolism, sexual function and indices related to quality of life, besides safety parameters. These studies have included a limited number of men, are of relatively short duration, and measure intermediary clinical endpoints. SummaryTo date, intervention studies have included too few partially androgen deficient patients and were of too short duration to provide reliable data on long-term risks versus benefits of androgen replacement therapy in elderly men. In this context, treatment should be reserved for elderly men with clear hypogonadism.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"17 1","pages":"254–261"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000224805.31695.6a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61655706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-06-01DOI: 10.1097/01.med.0000224807.16448.77
J. Mir, R. Munarriz
Purpose of reviewIt is generally accepted that androgens are critical for mood, cognition, sex differentiation, development of male sexual characteristics and maintenance of bone density and muscle/fat ratio. Their role in sexual function and in particular in erectile physiology, however, remains controversial. A careful review of preclinical and clinical studies on the role of androgens and male sexual function was conducted. Recent findingsPreclinical studies suggest that androgens modulate penile trabecular smooth muscle, neural and extracellular matrix integrity and adipocyte accumulation and distribution. In addition, androgens upregulate neural and endothelial nitric oxide synthase and phosphodiesterase type 5. Clinical studies document a relationship between androgens and erectile function, nocturnal erections and sexual desire and activity. Androgen ablation results in decreased erectile function, sexual desire and activity in many men. Testosterone treatment may be able to restore male sexual function. In addition, testosterone replacement may be able to improve erectile function in men who have failed phosphodiesterase type 5 inhibitors. SummaryThe literature supports that androgens modulate male sexual function. The exact mechanisms by which androgens exert their activity is not completely understood, but it seems that androgens modulate penile tissue integrity as well as nitric oxide synthase and phosphodiesterase type 5 expression and activity.
{"title":"Androgens and male sexual dysfunction","authors":"J. Mir, R. Munarriz","doi":"10.1097/01.med.0000224807.16448.77","DOIUrl":"https://doi.org/10.1097/01.med.0000224807.16448.77","url":null,"abstract":"Purpose of reviewIt is generally accepted that androgens are critical for mood, cognition, sex differentiation, development of male sexual characteristics and maintenance of bone density and muscle/fat ratio. Their role in sexual function and in particular in erectile physiology, however, remains controversial. A careful review of preclinical and clinical studies on the role of androgens and male sexual function was conducted. Recent findingsPreclinical studies suggest that androgens modulate penile trabecular smooth muscle, neural and extracellular matrix integrity and adipocyte accumulation and distribution. In addition, androgens upregulate neural and endothelial nitric oxide synthase and phosphodiesterase type 5. Clinical studies document a relationship between androgens and erectile function, nocturnal erections and sexual desire and activity. Androgen ablation results in decreased erectile function, sexual desire and activity in many men. Testosterone treatment may be able to restore male sexual function. In addition, testosterone replacement may be able to improve erectile function in men who have failed phosphodiesterase type 5 inhibitors. SummaryThe literature supports that androgens modulate male sexual function. The exact mechanisms by which androgens exert their activity is not completely understood, but it seems that androgens modulate penile tissue integrity as well as nitric oxide synthase and phosphodiesterase type 5 expression and activity.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"267–271"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000224807.16448.77","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61655750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-06-01DOI: 10.1097/01.med.0000224810.62189.9d
S. Kalantaridou, K. Calis
Purpose of reviewTestosterone therapy for women, particularly those with natural or surgically induced menopause, albeit controversial, is becoming more widespread. This review presents current data regarding the effects of endogenous androgen and examines recent findings using testosterone therapy in women. Recent findingsCurrent evidence indicates that androgens have important biological effects in women, acting directly via androgen receptors in tissues, such as bone, skin fibroblasts, hair follicles and sebaceous glands. They also act indirectly via the aromatization of testosterone to estrogen on various sites, such as the ovaries, bone, brain, heart and adipose tissue. Data from randomized controlled trials suggest that exogenous testosterone therapy improves sexual function, mood, and bone mineral density in women with androgen insufficiency. SummaryAndrogen therapy may be necessary for the management of carefully selected women with androgen insufficiency. Women with natural or surgically induced menopause may be candidates for testosterone therapy if they have decreased sexual desire and no other identifiable cause for decreased libido. Data from studies investigating the effects of testosterone therapy in young women with androgen insufficiency are needed. Common adverse effects of testosterone therapy include hirsutism and acne, which reverse with discontinuation of treatment. Long-term trials evaluating safety and effectiveness of testosterone therapy in women are lacking.
{"title":"Androgen treatment in women","authors":"S. Kalantaridou, K. Calis","doi":"10.1097/01.med.0000224810.62189.9d","DOIUrl":"https://doi.org/10.1097/01.med.0000224810.62189.9d","url":null,"abstract":"Purpose of reviewTestosterone therapy for women, particularly those with natural or surgically induced menopause, albeit controversial, is becoming more widespread. This review presents current data regarding the effects of endogenous androgen and examines recent findings using testosterone therapy in women. Recent findingsCurrent evidence indicates that androgens have important biological effects in women, acting directly via androgen receptors in tissues, such as bone, skin fibroblasts, hair follicles and sebaceous glands. They also act indirectly via the aromatization of testosterone to estrogen on various sites, such as the ovaries, bone, brain, heart and adipose tissue. Data from randomized controlled trials suggest that exogenous testosterone therapy improves sexual function, mood, and bone mineral density in women with androgen insufficiency. SummaryAndrogen therapy may be necessary for the management of carefully selected women with androgen insufficiency. Women with natural or surgically induced menopause may be candidates for testosterone therapy if they have decreased sexual desire and no other identifiable cause for decreased libido. Data from studies investigating the effects of testosterone therapy in young women with androgen insufficiency are needed. Common adverse effects of testosterone therapy include hirsutism and acne, which reverse with discontinuation of treatment. Long-term trials evaluating safety and effectiveness of testosterone therapy in women are lacking.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"284–290"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000224810.62189.9d","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61655818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-06-01DOI: 10.1097/01.med.0000224806.08824.dc
H. Daniell
Purpose of reviewOpioid-induced androgen deficiency has become one of the most common causes of testosterone deficiency among men in many communities. Its increase parallels the large increase in opioid use. This form of hypogonadotrophic hypogonadism is present in most men chronically consuming sustained-action opioids, including those receiving methadone for heroin addiction and those consuming opioids for control of either malignant or non-malignant chronic pain. A similar, but less well defined illness occurs in women. Opioid-induced androgen deficiency is not widely recognized. This review examines its pathophysiology, some of its signs and symptoms, and indicates some areas where current observations suggest additional investigations would be fruitful. Recent findingsRecognition of opioid-induced androgen deficiency in men not receiving methadone for heroin addiction is a new observation, and in these men contributes to fatigue, depression, vasomotor phenomena, anemia, diminished libido, erectile dysfunction and osteoporosis. These signs and symptoms improved during testosterone replacement therapy in several small non-placebo-controlled trials. SummaryA large majority of men consuming sustained-action opioids have symptomatic androgen deficiency which apparently responds to replacement therapy. Opioid-induced androgen deficiency is frequently overlooked, with its symptoms attributed to underlying disease states including malignant disease, chronic back disorders, HIV disease, and psychosocial illnesses contributing to opioid habituation.
{"title":"Opioid-induced androgen deficiency","authors":"H. Daniell","doi":"10.1097/01.med.0000224806.08824.dc","DOIUrl":"https://doi.org/10.1097/01.med.0000224806.08824.dc","url":null,"abstract":"Purpose of reviewOpioid-induced androgen deficiency has become one of the most common causes of testosterone deficiency among men in many communities. Its increase parallels the large increase in opioid use. This form of hypogonadotrophic hypogonadism is present in most men chronically consuming sustained-action opioids, including those receiving methadone for heroin addiction and those consuming opioids for control of either malignant or non-malignant chronic pain. A similar, but less well defined illness occurs in women. Opioid-induced androgen deficiency is not widely recognized. This review examines its pathophysiology, some of its signs and symptoms, and indicates some areas where current observations suggest additional investigations would be fruitful. Recent findingsRecognition of opioid-induced androgen deficiency in men not receiving methadone for heroin addiction is a new observation, and in these men contributes to fatigue, depression, vasomotor phenomena, anemia, diminished libido, erectile dysfunction and osteoporosis. These signs and symptoms improved during testosterone replacement therapy in several small non-placebo-controlled trials. SummaryA large majority of men consuming sustained-action opioids have symptomatic androgen deficiency which apparently responds to replacement therapy. Opioid-induced androgen deficiency is frequently overlooked, with its symptoms attributed to underlying disease states including malignant disease, chronic back disorders, HIV disease, and psychosocial illnesses contributing to opioid habituation.","PeriodicalId":88857,"journal":{"name":"Current opinion in endocrinology & diabetes","volume":"13 1","pages":"262–266"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.med.0000224806.08824.dc","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61655713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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