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San Giovanni Rotondo, Italy

Corona G.,Endocrinology Unit | Maggi M.,University of Florence
Archivos Espanoles de Urologia

The prevalence of diabetes mellitus (DM) is increasing worldwide for all ages due to population growth, aging, and increased prevalence of obesity and physical inactivity. Sexual dysfunction and in particular erectile dysfunction (ED) are frequent complications of DM. In patients with DM, ED can be considered as a useful sign of silent myocardial ischemia. A large body of evidence also supports a strong association between DM, cardiovascular risk (CV) and testosterone deficiency syndrome. Despite this evidence, the screening of ED and hypogonadism in the diabetic population remains poorly implemented. In addition, data regarding the role of testosterone replacement therapy (TRT) for glycometabolic control and CV risk remains contradictory. In the present paper we have reviewed the available evidence and based our discussion on data derived from a specific clinical case. Hypogonadism is frequently observed in subjects with type 2 DM (T2DM) and especially those complaining of ED. Obesity and insulin-resistance are probably the most important pathogenetic factors involved, and, according to the current guidelines, subjects with T2DM should be screened for hypogonadism. TRT is the first line option in hypogonadal subjects with ED, however, the possible role of TRT in improving glycometabolic control and CV outcomes needs to be confirmed through longer and larger studies. Source

Corona G.,Endocrinology Unit | Giorda C.B.,Metabolism and Diabetes Unit | Cucinotta D.,Policlinico di Messina | Guida P.,University of Bari | Nada E.,Chaira Medical Association
Journal of Sexual Medicine

Introduction: Several data have emphasized the importance of early diagnosis of erectile dysfunction (ED) and meticulous cardiovascular investigation in the type 2 diabetic mellitus (T2DM) patients. Aim: To estimate the prevalence of ED and its associated determinants in a sample of male patients with new or recently diagnosed T2DM. Methods: The SUBITO-DE study is an observational, multicenter, prospective study involving 27 Italian diabetes centers. Male patients recently diagnosed with T2DM were consecutively interviewed by their attending physician at the diabetes care centers and asked whether they had experienced a change in their sexual function or found it unsatisfactory. Those responding positively were then invited to participate in the study. Main Outcome Measure: Several hormonal and biochemical parameters were studied. Results: A nonselected series of 1,503 patients was interviewed, 499 of which (mean age, 58.8±8.8 years) entered the study, yielding a final enrolment rate of 33.3%. ED was classified as mild in 19.4%, mild-to-moderate in 15.4%, moderate in 10.4%, and severe in 21.6% of patients, respectively. In addition, premature ejaculation, delayed ejaculation, and hypoactive sexual desire (HSD) were comorbid in 28.3%, 32.9%, and 58.4%, respectively. Finally, hypogonadism, showed an estimated prevalence of almost 20%. Both organic (at least one chronic DM-associated complication) and psychological factors (severe depressive symptoms) increased the risk of ED. Severe depressive symptoms were also associated with ejaculatory problems, HSD, and hypogonadism. Conclusions: A high prevalence of sexual dysfunction in men with recently diagnosed T2DM was detected. Early diagnosis of ED could help prevent emotional and physical discomfort in men and aid in identifying reversible cardiovascular risk factors. Screening of sexual dysfunction should become a part of routine care in the management of T2DM patients. Corona G, Giorda CB, Cucinotta D, Guida P, Nada E, and Gruppo di studio SUBITO-DE. Sexual dysfunction at the onset of type 2 diabetes: The interplay of depression, hormonal and cardiovascular factors. J Sex Med 2014;11:2065-2073. © 2014 International Society for Sexual Medicine. Source

Bouchard P.,Endocrinology Unit | Bouchard P.,University Pierre and Marie Curie | Chabbert-Buffet N.,University Pierre and Marie Curie | Fauser B.C.J.M.,University Utrecht
Fertility and Sterility

Objective: To discuss the mechanism of action of selective progesterone receptor modulators (SPRMs) and summarize the preclinical and clinical efficacy and safety data supporting the potential use of these compounds for gynecologic indications. Design: Relevant publications from 2005 onward were identified using a PubMed search. Additional relevant articles were identified from citations within these publications. Setting: None. Patient(s): None. Intervention(s): None. Main Outcome Measure(s): None. Result(s): Mifepristone was first developed as a progesterone receptor antagonist and licensed for pregnancy termination because of the unique property of this compound to terminate pregnancy when associated with prostaglandins. Then SPRMs were developed, and among those ulipristal acetate, an efficient emergency contraceptive. Because SPRMs effectively inhibit endometrial proliferation and reduce endometriotic lesions in animal models, this suggests a possible role in the treatment of endometriosis in humans. Finally, a number of double-blind, randomized, placebo-controlled trials have demonstrated the efficacy of asoprisnil, mifepristone, telapristone acetate, and ulipristal acetate in reducing leiomyoma and uterine volume, and suppressing bleeding in women with uterine fibroids. Conclusion(s): Mifepristone in combination with prostaglandins has been licensed for pregnancy termination because of its unique ability is this area. Ulipristal acetate is available for emergency contraception. Several SPRMs hold further promise as an effective medical therapy for patients suffering from endometriosis and leiomyoma. © 2011 American Society for Reproductive Medicine. Source

Corona G.,Endocrinology Unit | Rastrelli G.,University of Florence | Maseroli E.,University of Florence | Forti G.,University of Florence | Maggi M.,University of Florence
Best Practice and Research: Clinical Endocrinology and Metabolism

With the progressive increase in the proportion of older people, there is an increasing interest in characterizing the modifications of sexual health and the effect of its perturbations as a function of the aging process. The aim of this review is to summarize the available evidence regarding the age-dependent modifications of male sexual function and their interaction with general health and age-dependent modification of endocrine function. Elderly patients are often affected by multiple organic diseases which can interfere with sexual function. Despite this evidence, several studies have indicated that, with advancing age, normal erections are not an absolute prerequisite to remain sexually active. Good physical health, the availability of a partner, and a regular and stable pattern of sexual activity earlier in life predict the maintenance of sexual activity in old age. Conversely, there are no convincing data that hormonal changes, associated with aging, have a primary role in underlying changes in sexual function in healthy aging men. Nonetheless, sexual dysfunctions especially in elderly people are poor investigated. Asking about sexual health remains difficult or embarrassing for many primary care physicians. In addition, many patients find it difficult to raise sexual issues with their doctor. This situation often results in sexual issues not being adequately addressed thus resulting in depression, social withdrawal and delayed diagnosis of underlying medical conditions often resulting in forthcoming cardiovascular events. Education and permission from a health care professional may help to alter such misconceptions. Information from physicians regarding normal age-related changes in sexuality and encouragement, together with advice on how to continue meaningful sexual relations, may play a key role in altering such negative attitudes. © 2013 Published by Elsevier Ltd. Source

Gandolfi G.,Laboratory of Molecular Biology | Sancisi V.,Laboratory of Molecular Biology | Torricelli F.,Laboratory of Molecular Biology | Ragazzi M.,Pathology Unit | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism

Context: The relevance of the BRAF V600E mutation in papillary thyroid carcinoma (PTC) as a negative prognostic factor is a subject of intense debate. This mutation has been associated with several clinicopathological features, but the lack of consistency among data does not support its usefulness as marker of tumor aggressiveness and poorer outcome. Due to the genetic heterogeneity of the tumor, both the occurrence and the allele percentage of the BRAF mutation should be considered to unravel this controversy. Objective: We aimed to evaluate the impact of the BRAF V600E mutation occurrence and the allele percentage on the metastatic process in PTCs. Study Design: The presence and allele percentage of the BRAF mutation were determined by pyrosequencing in 132 cases of well-differentiated PTCs with (n = 37) or without lymph node metastases (LNMs) (n = 95) and in 40 LNMs matched with 35 PTCs. Results: No significant differences were observed in either the occurrence or the allele percentage of V600E mutation between the 2 groups of PTCs with or without LNMs. The LNMs were heterogeneous for the V600E mutation as the primary lesions. Conclusions: In this study, the occurrence and percentage of the BRAF V600E mutated allele was not preferentially associated with the development of metastases and the average mutated allele percentage decreased as the tumor progresses from the primary site to the lymph node metastatic sites. These observations support the need to reevaluate the role of the BRAF V600E mutation as a negative prognostic marker in PTCs. Copyright © 2013 by The Endocrine Society. Source

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