Endocrine Abstracts

Background: In patients affected with type 2 diabetes mellitus (T2DM) a high prevalence of hypogonadism has been reported, even if there is no consensus on its metabolic and cardiovascular implications, especially according to the type of hypogonadism. The aim of this observational study is to evaluate: (1) the prevalence of different types of hypogonadism in T2DM according to validated criteria from the EMAS study; (2) look for correlations of gonadal status with severity or duration of diabetes, its complications, dyslipidemia, therapies, BMI, age and smoking habit; (3) the incidence according to the gonadal function of major adverse cardiovascular events (MACE) intended as acute coronary syndrome, cerebrovascular events and/or newly diagnosed coronaropathy requiring revascularization;

Patients and Methods: We evaluated 106 male patients, consecutively enrolled in diabetology clinics, between 18 and 80 years old; patients with already known pituitary or gonadal diseases, acute diseases, malnutrition, or using interfering drugs were excluded. Each patient underwent a complete evaluation of the gonadal axis including SHBG to define his gonadal status (according to EMAS criteria), a treadmill test, and information on diabetes and its complications, therapies, glucose and lipidic metabolism was collected. Only 7 began testosterone replacement therapy (TRT) after diagnosing hypogonadism. A follow up of 36 months was carried out to look for MACEs.

Results: We found evidence of hypogonadism in 49% of T2DM patients: 31% of them having hypogonadotropic forms (HH), and 18% having primary hypogonadism (PH). PH was found to be associated with higher age, and creatinine levels, whereas HH was directly correlated with BMI. Finally, we found a significant increase in MACEs at 36 months in HH compared to other patients (Fisher test P=0.047), no one after the beginning of testosterone treatment.

Conclusions: We found a higher prevalence of HH e PH in T2DM outpatients than previously reported due to the finding of compensated PH and mild HH, which can be diagnosed only evaluating gonadotropins and SHBG respectively. We confirmed the known association of HH with BMI, and the correlation of PH with age and creatinine, suggesting different clinical implications for these two forms of hypogonadism and a possible effect of renal function on testicular ageing, or a common cause for organ dysfunction. Finally, the significantly higher prevalence of three years MACEs in HH could suggest this condition as a sign of cardiovascular disease and hints at a possible role of gonadal axis function as a predictive factor in T2DM.