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Secondary Hypogonadism and Effects of Testosterone Replacement Therapy on Cardiovascular Events
Vicki Munro1, Jocelyn Law1, Kara Matheson2
1Division of Endocrinology, Department of Medicine, Dalhousie University, Halifax, Canada NS B3H 2Y9.
Context:
The safety of testosterone replacement therapy (TRT) has generated some controversy during recent years. While untreated hypogonadism leads to diminished sexual characteristics, muscle weakness and osteoporosis, the cardiovascular safety of TRT has been vigorously debated. TRT remains the standard of care for those with secondary hypogonadism (SHG) due to structural pituitary disease, but long-term cardiovascular safety in this population remains unclear.
Methods:
We conducted a retrospective cohort study to investigate occurrence of major adverse cardiovascular events (MACE) in male patients with nonfunctioning pituitary adenomas and prolactinomas, with and without SHG. Demographic data, TRT treatment, stroke, myocardial infarction, and mortality data were retrieved from chart review as well as provincial cardiac and stroke registries.
Results:
There were 408 patients followed for a median 8.1 years (interquartile range 3.3-14.1); 150 (36.7%) did not have SHG, whereas 214 (52.5%) had SHG adequately treated with TRT and 44 (10.8%) had SHG that was untreated. Multivariable logistic regression analysis demonstrated no significant difference in MACE between groups. MACE outcomes were not impacted by size of adenoma, presence of other pituitary hormonal deficits, or testosterone levels. There was increased risk of mortality in untreated SHG compared to both TRT-treated SHG and those without SHG.
Conclusion:
TRT does not appear to increase risk of MACE in those with SHG related to pituitary disorders. Untreated SHG appears to convey increased risk of mortality though these patients were older and more comorbid.
Insights
Testosterone replacement therapy (TRT) does not increase major adverse cardiovascular events (MACE) in men with secondary hypogonadism (SHG) from pituitary disorders. However, untreated SHG is linked to a higher mortality risk.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Oncology
Background:
- The cardiovascular (CV) safety of testosterone replacement therapy (TRT) is debated.
- Secondary hypogonadism (SHG) due to pituitary disease requires TRT, but its long-term CV safety is unclear.
Purpose of the Study:
- To investigate the occurrence of major adverse cardiovascular events (MACE) in male patients with pituitary adenomas and SHG, with or without TRT.
Main Methods:
- Retrospective cohort study of 408 male patients with pituitary adenomas.
- Data on MACE, TRT, and mortality collected via chart review and registries.
- Analysis included patients with and without SHG, and those treated or untreated with TRT.
Main Results:
- No significant difference in MACE was found between groups (no SHG, TRT-treated SHG, untreated SHG).
- Adenoma size, other hormonal deficits, or testosterone levels did not impact MACE.
- Untreated SHG showed an increased risk of mortality compared to treated SHG and no SHG groups.
Conclusions:
- TRT is not associated with increased MACE in SHG patients with pituitary disorders.
- Untreated SHG may increase mortality risk, potentially influenced by age and comorbidities.
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