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Hypogonadism and sexual function in men affected by adrenocortical carcinoma under mitotane therapy
Letizia Canu1,2,3,4, Clotilde Sparano1,2, Lara Naletto1
1Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
Purpose:
Adrenocortical carcinoma (ACC) is a rare and aggressive tumor. ACC male patients under adjuvant mitotane therapy (AMT) frequently develop hypogonadism, however sexual function has never been assessed in this setting. The aim of this retrospective study was to evaluate in AMT treated ACC patients the changes in Luteinizing hormone (LH), Sex Hormone Binding Globulin (SHBG), total testosterone (TT) and calculated free testosterone (cFT), the prevalence and type of hypogonadism and sexual function, the latter before and after androgen replacement therapy (ART).
Methods:
LH, SHBG, TT and cFT were assessed in ten ACC patients at baseline (T0) and six (T1), twelve (T2), and eighteen (T3) months after AMT. At T3, ART was initiated in eight hypogonadal patients, and LH, SHBG, TT and cFT levels were evaluated after six months (T4). In six patients, sexual function was evaluated before (T3) and after (T4) ART using the International Index of Erectile Function-15 (IIEF-15) questionnaire.
Results:
Under AMT we observed higher SHBG and LH and lower cFT levels at T1-T3 compared to T0 (all p<0.05). At T3, hypergonadotropic hypogonadism and erectile dysfunction (ED) were detected in 80% and 83.3% of cases. At T4, we observed a significant cFT increase in men treated with T gel, and a significant improvement in IIEF-15 total and subdomains scores and ED prevalence (16.7%) in men under ART.
Conclusion:
AMT was associated with hypergonatropic hypogonadism and ED, while ART led to a significant improvement of cFT levels and sexual function in the hypogonadal ACC patients. Therefore, we suggest to evaluate LH, SHBG, TT and cFT and sexual function during AMT, and start ART in the hypogonadal ACC patients with sexual dysfunction.
Insights
Adjuvant mitotane therapy for adrenocortical carcinoma causes hypogonadism and erectile dysfunction. Androgen replacement therapy improved testosterone levels and sexual function in affected male patients.
Area of Science:
- Endocrinology
- Oncology
- Sexual Medicine
Background:
- Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy.
- Male ACC patients on adjuvant mitotane therapy (AMT) often develop hypogonadism.
- Sexual function in this patient group remains understudied.
Purpose of the Study:
- To assess hormonal changes (LH, SHBG, TT, cFT) in ACC patients on AMT.
- To determine the prevalence and type of hypogonadism and sexual dysfunction.
- To evaluate the impact of androgen replacement therapy (ART) on sexual function.
Main Methods:
- Retrospective analysis of hormone levels (LH, SHBG, TT, cFT) in 10 ACC patients over 18 months of AMT.
- Assessment of hypogonadism and sexual function (IIEF-15) before and after ART in 8 hypogonadal patients.
- Hormonal levels were measured at baseline and multiple time points during AMT and ART.
Main Results:
- AMT was associated with elevated SHBG and LH, and decreased cFT.
- At 18 months, 80% of patients had hypergonadotropic hypogonadism and 83.3% had erectile dysfunction (ED).
- ART significantly increased cFT and improved IIEF-15 scores, reducing ED prevalence to 16.7%.
Conclusions:
- AMT contributes to hypergonadotropic hypogonadism and ED in ACC patients.
- ART effectively improves testosterone levels and sexual function in hypogonadal ACC patients.
- Routine monitoring of hormones and sexual function during AMT is recommended, with timely ART initiation for dysfunction.
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