DIAGNÓSTICO CLÍNICO Y BIOQUÍMICO DEL DÉFICIT ANDROGÉNICO EN ELVARÓN ADULTO

Manuel Mas

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Archivos Españoles de Urología ›› 2013, Vol. 66 ›› Issue (7) : 639-651.
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DIAGNÓSTICO CLÍNICO Y BIOQUÍMICO DEL DÉFICIT ANDROGÉNICO EN ELVARÓN ADULTO

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The diagnosis of testosterone deficit (TD)in adult men is made upon the finding of consistentsymptoms or signs associated with confirmed lowTestosterone levels. TD can be caused by primarytesticular failure, decreased LH secretion (secondary) ora combination of both (mixed type).The clinical features of TD depend on the age of onset.Before completion of pubertal development it results ineunuchoid traits that can be easily detected. The clinicalexpression of adult onset TD is protean, with variedsymptoms and signs often overlapping with those ofaging and several chronic conditions. Sexual problemsas low desire and difficult erections are frequentlyreported by TD patients. Several symptom questionnaireshave been proposed for detecting TD. However, poorspecificity and weak correlation with serum testosteronemake them unsuitable as diagnostic tools, although theirscores can help for monitoring future treatments. Physicalexamination usually yields few significant data but it canhelp for detecting unidentified cases of early onset TD.Measuring serum total testosterone(TT) levels ismandatory. It is available in most laboratories althoughcommonly used methods are not fully satisfactory. Inadult men the lower limit for the normal reference rangeis around 10 nmol/ L, but this figure can vary amonglaboratories. “Grey zone” values falling within a ± 20%interval around this limit need further clarification. To thisaim most hospital laboratories can calculate the free(FT) or bioavailable fractions (BioT) of TT, SHBG, andalbumin levels.When TD diagnosis is confirmed, a number ofadditional tests, such as measuring gonadotropins andprolactin, should be used to find out its etiology. Theyare summarized here in a diagnostic algorithm. There isa need for laboratory tests giving a reliable estimate ofthe androgen sensitivity of each subject

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Testicular tumor / Laparoscopy / Lymphadenectomy

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Manuel Mas. DIAGNÓSTICO CLÍNICO Y BIOQUÍMICO DEL DÉFICIT ANDROGÉNICO EN ELVARÓN ADULTO. Archivos Españoles de Urología. 2013, 66(7): 639-651

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