Hormone levels and Peyronie's disease: more than testosterone deficiency

2013/2014 Mariana Marques Martins Santiago Hormone levels and Peyronie’s disease: more than testosterone deficiency? março, 2014 Mestrado Integrado em Medicina Área: Urologia Trabalho efetuado sob a Orientação de: Professor Doutor João Nuno Tomada Marques Trabalho organizado de acordo com as normas da revista: The Journal of Sexual Medicine Mariana Marques Martins Santiago Hormone levels and Peyronie’s disease: more than testosterone deficiency? março, 2014 Letter to the Editor To the attention of: Irwin Goldstein, MD Editor-in-Chief of « The Journal of Sexual Medicine » Department of Sexual Medicine, Alvarado Hospital University of California San Diego, CA USA Oporto, March 18th, 2014 Dear Mr. Irwin Goldstein: Please accept the submission of the research article entitled: « Hormone levels and Peyronie’s disease: more than testosterone deficiency? » The mailing address is: Mariana Marques Martins Santiago Rua Afonso Baldaia, nº 775 bloco 781, apart. 341 4150-018 Oporto, PORTUGAL [email protected] Tel. +351918574751 The guarantor is myself, address above. I herewith declare that all authors, Mariana Santiago, Nuno Tomada and Francisco Botelho, have agreed upon this submission. Furthermore, I declare that the paper is not currently being considered for publication by another journal, and, if accepted, it will not subsequently be published in the same or similar form in any language without the written consent of the publisher. Thank you for your attention, Warm regards, Mariana Santiago, MD Supplementary file not for review Hormone levels and Peyronie’s disease: more than testosterone deficiency? Mariana Marques Martins Santiago, MD; Faculty of Medicine of Porto University, Porto, Portugal; [email protected] João Nuno Tomada Marques, MD, PhD; Department of Urology of S. João Hospital; Faculty of Medicine of Porto University; Institute for Molecular and Cell Biology of Porto University (IBMC), Porto, Portugal; Francisco Botelho, MD; Department of Urology, Braga Hospital, Braga, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine of Porto University, Porto, Portugal; [email protected] Address of corresponding author: Rua Afonso Baldaia, nº 775, bloco 781, apart. 341; 4150-018 Porto, Portugal; [email protected] ! Main manuscript explain not only the stimulation of FSH production, but also its influence on the severity of the disease. Moreover, we were the first to investigate if TD was associated with PDDU measurements in PD patients. These values were similar in groups 1 and 2, but as evidence reports a strong association between TD and ED in aging men [24] and ED is present in a high percentage of men with PD, varying from 20 to 54% [11, 25], this association may deserve further studies. There were some limitations in our study, one being its retrospective design. Because of small sample size, the statistical power of the analysis was limited. A 31-year age spread in a relatively small sample size of PD patients might have interfered with data analysis. Thus, studies using larger samples are still required to elucidate the true association between hormone levels and PD characteristics. Conclusion Our investigation suggested a possible relationship between hormone levels and PD, beyond TD. Furthermore, low levels of fT and bT were the biggest contribution to TD in PD patients. Although these parameters were not correlated with severity of PD, they were significantly lower in PD patients, corroborating the potential role of low testosterone in the pathophysiology of this disease. Therefore, further studies, namely prospective trials with a complete hormonal assessment in PD patients, are needed to confirm or refute this evidence. Conflict of Interest: None declared. 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Cavallini G, Biagiotti G, Lo Giudice C. Association between Peyronie disease and low serum testosterone levels: detection and therapeutic considerations. J Androl. 2012;33(3):381-8. 14. Tomada N, Tomada I, Botelho F, Cruz F, Vendeira P. Are all metabolic syndrome components responsible for penile hemodynamics impairment in patients with erectile dysfunction? The role of body fat mass assessment. J Sex Med. 2011;8(3):831-9. 15. Porst H, Buvat J. Standard practice in sexual medicine Oxford: Blackwell Publishers; 2006. 149–57 p. 16. Bjekic MD, Vlajinac HD, Sipetic SB, Marinkovic JM. Risk factors for Peyronie's disease: a case-control study. BJU Int. 2006;97(3):570-4. 17. Sturm R, Rumohr JA, Lipshultz LI, Mohamed O, Khera M. Increased incidence of hypogonadism in patients with a novel diagnosis of peyronie's disease as compared to organic erectile dysfunction. J Urol. 2009;181(4):2789. 18. Demling RH. The role of anabolic hormones for wound healing in catabolic states. 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Tables Table 1 Demographic, clinical and hormonal profiles of PD patients and control population PD patients Controls P value* Number of subjects 63 65 Age (years) 57.4 ± 6.8 51.8 ± 10.2 < 0.001 Hypertension 31 (53.4%) 24 (37.5%) 0.113 Diabetes mellitus 19 (35.2%) 24 (37.5%) 0.946 Hypercholesterolemia 20 (36.4%) 32 (54.2%) 0.084 Hypertriglyceridemia 13 (24.5%) 20 (33.9%) 0.380 Smoking < 0.001 - Never smoking 51 (82.3%) 25 (39.1%) - Current smoking 9 (14.5%) 17 (26.6%) - Past smoking 2 (3.2%) 22 (34.4%) Sex hormone-binding globulin (nmol/L) 36.8 (30.1-52.7) 35.8 (26.8-49.8) 0.312 Albumin (g/L) 44.1 ± 2.5 44.3 ± 2.9 0.600 Follicle-stimulating hormone (mIU/mL) 5.1 (4.0-7.8) 4.2 (3.3-6.2) 0.048 Luteinizing hormone (mIU/mL) 4.3 (3.3-5.9) 4.2 (2.9-5.6) 0.340 Total testosterone (ng/dL) 457.4 ± 172.6 484.6 ± 185.3 0.392 Free testosterone (ng/dL) 8.0 ± 2.3 9.15 ± 2.7 0.014 Bioavailable testosterone (ng/dL) 192.4 ± 56.8 221.1 ± 69.9 0.015 Prolactin (ng/ml) 7.9 ± 6.8 7.6 ± 3.4 0.800 Estradiol (pg/ml) 27.5 ± 13.3 32.2 ± 18.2 0.110 Estradiol (pg/ml)/total testosterone (ng/dL) 0.063 ± 0.032 0.077 ± 0.058 0.110 mPSV (cm/s) 49.3 ± 19.6 53.5 ± 14.5 0.235 mEDV (cm/s) 0.0 (0.0-5.1) 0.0 (0.0-3.8) 0.168 RI 1.0 (0.9-1) 1.0 (1.0-1.0) 0.054 Data are presented as the mean ± standard deviation, median (percentile 25-percentile 75) or number of subjects in each group with percentages in parentheses, as appropriate. PD = Peyronie’s disease; mPSV = mean values of Peak Systolic Velocity; mEDV = mean values of End-Diastolic Velocity; RI = Resistive Index. *Significance level at P < 0.05. ! ! ! ! Table 2 Distribution of Peyronie’s disease (PD) according to total testosterone (TT) levels Group 1 Group 2 P value* Number of subjects 18 45 0.475 Age (years) 56.1 ± 6.9 57.9 ± 6.8 0.345 Smoking (%) 0.262 - Never smoking 94.4 77.3 - Current smoking 5.6 18.2 - Past smoking 0.0 4.5 Hypercholesterolemia (%) 43.8 33.3 0.674 Hypertriglyceridemia (%) 26.7 23.7 0.822 Hypertension (%) 37.5 59.5 0.227 Diabetes mellitus (%) 43.8 31.6 0.587 Dupuytren’s contracture (%) 11.1 36.4 0.093 Total testosterone (ng/dL) 300.1 ± 46.5 520.3 ± 164.2 <0.001 Duration of PD (months) 10.6 ± 4.8 12.4 ± 10.4 0.481 History of penile trauma (%) 12.5 4.5 0.287 Pain on erection (%) 58.8 57.8 0.941 Plaque length (cm) 4.1 ± 1.6 3.2 ± 1.03 0.048 Plaque width (cm) 1.8 ± 0.6 1.9 ± 0.7 0.431 Curvature type (%) 0.987 - dorsal 61.1 64.4 - ventral 5.6 4.4 - lateral 27.8 24.4 - hourglass deformity 5.6 6.7 Curvature degrees 57.9 ± 20.2 54.8 ± 20.1 0.583 Curvature severity (%) 0.602 - < 30° (grade 1) 17.6 15.9 - 30-60° (grade 2) 29.4 43.2 - > 60° (grade 3) 52.9 40.9 Erectile dysfunction diagnosis (%) 0.394 - absence of erectile dysfunction 61.1 73.3 - arterial dysfunction 11.1 13.3 - venous-occlusive dysfunction 27.8 13.3 Data are presented as the mean ± standard deviation or percentage, as appropriate, for a total of 18 PD patients with TD (Group 1) and 45 patients with normal TT levels (Group 2). mPSV = mean values of Peak Systolic Velocity; mEDV = mean values of End-Diastolic Velocity; RI = Resistive Index.*Significance level at P < 0.05. ! ! ! mPSV (cm/s) 50.00 ± 24.2 48.99 ± 17.6 0.870 mEDV (cm/s) 3.56 ± 5.3 3.22 ± 4.3 0.813 RI 0.93 0.95 0.451 Agradecimentos Ao Prof. Doutor Nuno Tomada, meu orientador, pela disponibilidade e revisão da presente dissertação. 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