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Frontiers in Medicine 2024Non-gestational choriocarcinoma, also known as primary choriocarcinoma, is extremely rare in men, manifesting with specific signs such as breast feminization, testicular...
BACKGROUND
Non-gestational choriocarcinoma, also known as primary choriocarcinoma, is extremely rare in men, manifesting with specific signs such as breast feminization, testicular atrophy, and loss of libido. The presentation typically includes elevated serum β-hCG levels, widespread metastatic disease, and a rapid progression of the condition.
CASE REPORT
We present a rare case of a 41-year-old man diagnosed with choriocarcinoma, exhibiting a unique combination of multiple metastases, including lung, brain, bone, and retroperitoneal lymph node metastases, as confirmed by F-FDG PET/CT imaging. The patient was treated with aggressive chemotherapy and pembrolizumab, and the prognosis remained poor. The patient's overall survival was a mere 5 months following diagnosis.
CONCLUSION
Non-gestational choriocarcinoma represents a rare entity in clinical practice and should be considered in young men presenting with gynaecomastia and elevated β-hCG levels alongside normal gonads. Thus, we advocate for a more comprehensive inquiry into medical history and a systematic examination. The F-FDG PET/CT examination not only visually delineates the lesion's location and extent but also serves as a cornerstone for clinical tumor staging, providing valuable support for treatment monitoring and subsequent follow-up.
PubMed: 38572155
DOI: 10.3389/fmed.2024.1382672 -
Frontiers in Endocrinology 2024Triple A syndrome, caused by autosomal recessively inherited mutations in the gene is characterized by alacrima, achalasia, adrenal insufficiency, and neurological...
OBJECTIVE
Triple A syndrome, caused by autosomal recessively inherited mutations in the gene is characterized by alacrima, achalasia, adrenal insufficiency, and neurological impairment. To the best of our knowledge, no patients of both sexes have been reported to have offspring. Our aim was to assess the causes of infertility in male patients with this multisystemic syndrome, and to present a female patient that spontaneously conceived a child.
DESIGN
Cross-sectional study.
METHODS
Six males aged 19-48 years were included. Gonadotropins, testosterone, DHEAS, androstenedione, inhibin B, anti-Mullerian hormone measurements and testicular ultrasound were performed.
RESULTS
All six male patients had impaired general health and neurological symptoms including erectile and ejaculatory dysfunction. None of them had an offspring. The only demonstrated cause of infertility in our male patients was erectile and ejaculatory dysfunction which precludes sexual intercourse. Our patients had normal libido but were sexually abstinent. Except for low adrenal androgen levels, the concentrations of all measured hormones as well as testicular ultrasound were normal which may indicate the possibility of spermatogenesis in male patients with triple A syndrome. Little is known about fertility in female patients, but based on our observations spontaneous pregnancies seem to be possible.
CONCLUSION
Our results contribute to still scarce knowledge on fertility in patients with Triple A syndrome and as well represents a foundation for further research on causes of infertility and possible treatment options.
Topics: Child; Humans; Male; Female; Esophageal Achalasia; Cross-Sectional Studies; Adrenal Insufficiency; Infertility; Sexual Behavior; Fertility
PubMed: 38544685
DOI: 10.3389/fendo.2024.1357084 -
Frontiers in Psychology 2024Symptom distress and impaired psychological well-being after liver transplantation may lead to limitations in everyday activities and lowered health-related quality of...
INTRODUCTION
Symptom distress and impaired psychological well-being after liver transplantation may lead to limitations in everyday activities and lowered health-related quality of life. The aim of this nationwide, descriptive, and cross-sectional study was to explore self-reported symptom occurrence and distress, among Danish liver transplant recipients, and their association with self-reported psychological well-being as well as demographic, and clinical characteristics.
METHODS
Liver transplant recipients transplanted from 1990 to 2022 were included. All recipients were asked to complete the Organ Transplant Symptom and Wellbeing instruments consisting of two instruments measuring self-reported symptom occurrence and distress, respectively, as well as self-reported psychological well-being by the Psychological General well-being instrument.
RESULTS
Of 511 invited recipients 238 responded: 116 women and 122 men with a median post-transplant follow-up of 7.5 years (IQR 3.6-14.2 years). The most common single symptoms reported were decreased libido (18%), diarrhea (10%), and headache (8%). Sleep problems were the most common transplant-specific domain. 41% of the recipients reported poor psychological well-being, especially those who had undergone transplantation within the last 5 years, women, and younger recipients.
DISCUSSION
In the interest of equity, the fact that women reported a higher level of symptom distress than men requires attention. Research on symptom management support is warranted with interventions focusing on how to alleviate symptom distress, which might increase long-term survival, which has not improved in recent decades.
PubMed: 38544518
DOI: 10.3389/fpsyg.2024.1354706 -
Journal of Personalized Medicine Feb 2024The impact of stroke on the sexual functioning of female survivors can arise from direct neurological effects or be triggered indirectly through various... (Review)
Review
The impact of stroke on the sexual functioning of female survivors can arise from direct neurological effects or be triggered indirectly through various psychophysiological processes. Although an increasing number of publications exist, the topic of sexuality remains seldom discussed in the stroke literature, even though patients have expressed a need for sexual rehabilitation services. A literature review on sexual functioning in post-stroke females examining existing rehabilitation programs addressing patients' sexuality and exploring the perspectives of nurses and caregivers on sexual issues constitutes a novel approach. Therefore, we conducted a scoping review to better investigate this hot topic. Studies were identified by searching Scopus, PubMed, Web of Science, Cochrane Library, PsychINFO, and Embase databases. Current data indicates substantial connections between stroke and female sexual dysfunction (SD), including factors like desire/libido, sexual satisfaction, and sexual intercourse. Some intervention programs have been created to provide specific guidance to healthcare professionals in addressing patients' requirements for sexual recovery, although their adequacy remains uncertain. However, to date, there are neither specific rehabilitation programs for post-stroke female SD nor healthcare personnel trained to deal with post-stroke sexual issues adequately and efficiently. The incorporation of sexual rehabilitation into the overall rehabilitation process for stroke patients is crucial, ideally within an interdisciplinary framework. Despite being a fundamental aspect of post-stroke women's lives, sexuality remains taboo.
PubMed: 38541009
DOI: 10.3390/jpm14030267 -
Endocrinology, Diabetes & Metabolism... Jan 2024Functioning gonadotroph adenomas with clinical manifestations are extremely rare and the majority of these are FSH-secreting macroadenomas. Clinical symptoms are due to...
SUMMARY
Functioning gonadotroph adenomas with clinical manifestations are extremely rare and the majority of these are FSH-secreting macroadenomas. Clinical symptoms are due to excess gonadotrophins and sex hormones, and these may be present for a long time before the diagnosis of pituitary adenoma is made. We present the case of a 37-year-old Caucasian male with clinical manifestations of an FSH-secreting pituitary macroadenoma. He had sexual dysfunction for a year followed by bilateral testicular pain and enlargement which was initially treated as suspected recurrent epididymitis, but his symptoms did not resolve. He presented a year later with headaches and bilateral superior temporal visual field defects. Brain imaging confirmed a pituitary macroadenoma with optic chiasm compression. Pituitary profile demonstrated an unusually high FSH with high normal LH and normal testosterone level. The patient successfully underwent transsphenoidal hypophysectomy and histology confirmed gonadotroph differentiation and immunoreactivity predominantly with FSH. Gonadotrophin levels and testosterone dropped significantly after surgery, and he was started on testosterone replacement. MR imaging, 2 years post surgery, showed no recurrence of pituitary adenoma. In conclusion, testicular enlargement and hypogonadal symptoms associated with low testosterone levels are recognised features in FSH-secreting pituitary adenomas. Our patient had hypogonadal symptoms but consistently high normal testosterone levels prior to surgery. The reason for low libido despite high testosterone is unclear. Our case highlights the need to suspect such rare underlying pituitary pathology when dealing with unusual combinations of hypogonadal symptoms, testicular enlargement with low or normal testosterone levels.
LEARNING POINTS
Functioning pituitary adenomas that secrete excess follicle-stimulating hormone (FSH) are very rare and often present with symptoms related to pituitary mass effect. Testicular enlargement alongside sexual dysfunction are commonly reported symptoms amongst male patients. Pituitary profile results demonstrate a raised FSH level with either a low, normal, or even high testosterone level which may not always correlate to clinical symptoms. Pituitary pathology should be considered in males presenting with unusual combinations of testicular enlargement and hypogonadal symptoms even with normal testosterone levels.
PubMed: 38520752
DOI: 10.1530/EDM-23-0143 -
Women's Health (London, England) 2024Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side... (Review)
Review
Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.
Topics: Female; Humans; Breast Neoplasms; Cancer Survivors; Vaginismus; Sexual Dysfunction, Physiological; Sexual Behavior; Survivors
PubMed: 38481086
DOI: 10.1177/17455057241237687 -
International Journal of Endocrinology 2024Hypogonadism is frequent among HIV-infected males and might have significant clinical impact leading to sexual impairment and metabolic derangement. There is limited...
BACKGROUND
Hypogonadism is frequent among HIV-infected males and might have significant clinical impact leading to sexual impairment and metabolic derangement. There is limited information about the magnitude of hypogonadism and its associated factors among people living with HIV in Tanzania. We aimed to determine the prevalence of hypogonadism and associated risk factors among newly diagnosed ART naïve HIV-infected men in Mwanza, Tanzania.
METHODS
Newly diagnosed ART naïve HIV-infected men were enrolled at Voluntary Counseling and Testing Centres of four selected hospitals in the Mwanza region and subjected to thorough clinical and general physical examination including anthropometric measurements. A prestructured questionnaire was used to collect sociodemographic characteristics and clinical data. Serum total testosterone, follicle-stimulating hormone, luteinizing hormone, and estradiol were estimated. Serum total testosterone <300 ng/dl or testosterone >300 ng/dl with high LH and FSH (compensatory hypogonadism) was taken as markers of hypogonadism. Data were analyzed using STATA version 15.
RESULTS
Of the 388 enrolled participants, hypogonadism was found in 47.9%, with secondary hypogonadism (83.9%, 156/186) being the most frequent form. Logistic regression analysis showed a significant association between hypogonadism and CD4+ count (OR 2.0; 95% CI 1.1-3.6; =0.022), decreased libido (OR 1.6; 95% CI 1.1-2.4; =0.024), age of above 46 years (OR 2.3; 95% CI 1.1-4.6; =0.023), herbal medicine use (OR 2.4; 95% CI 1.5-3.9; < 0.001), WHO clinical stage 3 (OR 2.7; 95% CI 1.4-5.2; =0.003), and weight loss (OR 1.8; 95% CI 1.1-3.0; =0.016).
CONCLUSION
Hypogonadism was found in nearly half (47.9%) of ART naïve HIV-infected men. The majority (83.9%) had secondary hypogonadism. There was a significant association of hypogonadism with older age, herbal medicine use, weight loss, advanced clinical stage, CD4+ count, and decreased libido.
PubMed: 38476640
DOI: 10.1155/2024/9679935 -
Food Science & Nutrition Mar 2024The ketogenic diet (KD) is recognized as minimum carbohydrate and maximum fat intakes, which leads to ketosis stimulation, a state that is thought to metabolize fat more... (Review)
Review
The ketogenic diet (KD) is recognized as minimum carbohydrate and maximum fat intakes, which leads to ketosis stimulation, a state that is thought to metabolize fat more than carbohydrates for energy supply. KD has gained more interest in recent years and is for many purposes, including weight loss and managing serious diseases like type 2 diabetes. On the other hand, many believe that KD has safety issues and are uncertain about the health drawbacks. Thus, the outcomes of the effect of KD on metabolic and non-metabolic disease remain disputable. The current narrative review aims to evaluate the effect of KD on several diseases concerning the human health. To our best knowledge, the first report aims to investigate the efficacy of KD on multiple human health issues including type 2 diabetes and weight loss, cardiovascular disease, kidney failure and hypertension, non-alcoholic fatty liver, mental problem, oral health, libido, and osteoporosis. The literature searches were performed in Databases, PubMed, Scopus, and web of Science looking for both animal and human model designs. The results heterogeneity seems to be explained by differences in diet composition and duration. Also, the available findings may show that proper control of carbohydrates, a significant reduction in glycemic control and glycated hemoglobin, and weight loss by KD can be an approach to improve diabetes and obesity, hypertension, non-alcoholic fatty liver, PCOS, libido, oral health, and mental problem if isocaloric is considered. However, for some other diseases like cardiovascular disease and osteoporosis, more robust data are needed. Therefore, there is robust data to support the notion that KD can be effective for some metabolic and non-metabolic diseases but not for all of them. So they have to be followed cautiously and under the supervision of health professionals.
PubMed: 38455178
DOI: 10.1002/fsn3.3873 -
Archivio Italiano Di Urologia,... Mar 2024Non-obstructive azoospermia (NOA) represents an infertility problem that is usually difficult to treat. Such patients usually have testicular biopsy of germ cell aplasia...
BACKGROUND
Non-obstructive azoospermia (NOA) represents an infertility problem that is usually difficult to treat. Such patients usually have testicular biopsy of germ cell aplasia or spermatogenic arrest. In recent decades, mesenchymal stem cells (MSCs) had been studied thoroughly and proved safe and effective regarding their capability for trans-differentiation into different cell types. The aim of this study was to evaluate the effect of MSCs local intratesticular injection in induction of spermatogenesis.
PATIENTS AND METHOD
The current study included 87 infertile non-obstructive azoospermic patients. Clinical assessment and repeated semen analysis with centrifugation were done to confirm azoospermia. Karyotyping and AZF study were done. Some of the patients had previous testicular biopsy proving a lack of sperm in the testes. Single intratesticular injection of purified MSCs suspension was done.
RESULTS
20.7% of patients showed sperm in their semen after variable period of time. Hormonal profile among treated patients showed significant improvement regardless success of treatment. Also most of the treated patients appreciated the improvement of their sexual function and libido.
CONCLUSIONS
Bone marrow derived MSCs could be a new hope and therapeutic modality for treatment of refractory cases of NOA.
Topics: Humans; Male; Azoospermia; Semen; Testis; Spermatozoa
PubMed: 38451258
DOI: 10.4081/aiua.2024.12285 -
Journal of the West African College of... 2023Leydig cell tumors are rare but are the most common nongerm cell gonadal tumors. They are mostly benign but malignant variants have been reported. Leydig cells...
Leydig cell tumors are rare but are the most common nongerm cell gonadal tumors. They are mostly benign but malignant variants have been reported. Leydig cells constitute the main androgen-synthesizing compartment in adult males but are also capable of estrogen production. This can manifest with clinical features of excessive hormone elaboration. We report a case of a 39-year-old man with abnormal bilateral breast development, reduced libido, and weak erection of 3 years' duration. He never noticed any testicular swelling before presentation. Examination revealed well-developed breasts bilaterally and a mass in the lower pole of the left testis. Scrotal ultrasound confirmed a hypoechoic tumor measuring 2 × 3 cm in the lower pole of the left testis and hormonal evaluation revealed a markedly elevated estradiol level. A diagnosis of estrogen-secreting testicular tumor was made. He had a testis-sparing excision of the scrotal lesion as well as liposuction and excision of glandular tissues of the breasts. He had an uneventful postoperative recovery and was discharged a day after surgery. Histology of excised testicular lesion revealed a benign Leydig cell tumor. Four months following surgery, there was an improvement in libido, erection, and sperm concentration of the patient. The patient was also very satisfied with the cosmetic outcome of the excision of the bilateral gynecomastia. We recommend self-examination of testicles as an important step for early diagnosis of testicular tumors.
PubMed: 38449551
DOI: 10.4103/jwas.jwas_54_23