Hypogonadism as a Risk Factor for Metabolic Syndrome and Vascular Diseases in Patients with Germ Cell Tumors of the Testis After Treatment
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Abstract
In the last few decades the rate of testicular germ cell tumors (TGCTs) has been increased worldwide. This type of neoplasia is one of the main causes of cancer mortality in young men. But in the case of correct management, rational chemotherapy (CT) regimens and timely diagnosis, almost 95% of patients can achieve full recovery.
At the same time, there is an increased risk of side effects after CT, namely: infertility, hypogonadism, osteoporosis, cardiovascular diseases. Metabolic syndrome (MS) as a set of metabolic disorders based on hypertension, obesity, dyslipidemia, is associated with an increased risk of cardiovascular diseases.
The objective: to determine the incidence of metabolic syndrome (MS) in patients with TGCTs in five or more years after initial treatment.
Materials and methods. 68 patients with TGCTs 18-55 years old were examined. Unilateral high orchiectomy and follow-up observed management were performed in 14 patients, adjuvant chemotherapy for 1-2 cycles of PE (cisplatin + etoposide) or REВ (cisplatin + etoposide + bleocin) – in 22 persons, standard CT PE or REВ (<850 mg cisplatin) – 20 individuals, highdose CT for more than 4 cycles with the inclusion of cisplatin (total dose> 850 mg) – 12 patients. The control group included 29 men of the appropriate age.
During the study we determined: total testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH), high-density lipoprotein, triglycerides, glucose, waist circumference, blood pressure, body mass index (BMI). A comparative analysis of the results of treatment of all groups with the control group was performed.
Results. The analysis of risk factors for MS in patients with TGCTs after CT performed the significantly higher levels of triglycerides, high-density lipoproteins, elevated BMI. At the same time, the level of T was reduced in patients with MS. Hypogonadism was found in 12 (22 %) patients after CT and in 1 (6 %) patient with seminoma stage I after unilateral orchiectomy. MS was detected in 3 (24 %) of 12 patients with hypogonadism and in 9 (22 %) of the 42 patients in the CT group. However, in the patients with TGCTs with hypogonadism after CT, higher BMI and lower T levels were determined. T levels were lower and LH and FSH were higher in patients who received CT compared with the persons control group.
Conclusions. In the patients with testicular germ cell tumors with signs of hypogonadism there is a significantly higher risk of development of metabolic syndrome after chemotherapy. Such patients require long-term annual examination and monitoring of sex hormone levels.
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