4 5 Components of the metabolic syndrome in .NET framework

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3 4 5 Components of the metabolic syndrome
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Fig 63 Distribution of ED (IIEF score <21) among patients by the presence of 3 (n = 62), 4 (n = 25), and 5 (n = 13) components of the metabolic syndrome The differences between bars are signi cant (P < 005)
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6 functioning, including intensity of libido, frequency of nocturnal erections, and frequency of sexual activity [25,26] Furthermore, additional research in which an acute hypogonadal state was induced (in experimental animals and eugonadal males), not only con rmed the importance of physiologic levels of testosterone in maintaining normal sexual behavior, but also highlighted the dose response relationships between testosterone levels and the various androgen-dependent processes, including sexual function Other data suggests that hypogonadism may affect the ability of the erectogenic agents to fully restore erectile function Shabisgh et al [27] have shown that the addition of testosterone to hypogonadal men with testosterone de ciency, who additionally have had a suboptimal response to PDE-5 inhibitors, was highly bene cial Thus, a total and or free morning serum testosterone level may be indicated as a blood test for men with ED Con rmatory testing for a more comprehensive understanding of the etiology of the ED is optional, but should be available to the patient when appropriate Such testing may include nocturnal penile tumescence (NPT) testing, penile duplex ultrasonography with color Doppler, cavernosometry, cavernosography, neurophysiologic testing, of ce intracavernosal injection of a vasoactive agent, such as prostaglandin E1 (PGE1) All or some of these tests should be available to the patient as directed by the physician Controversy exists as to the usefulness, relative value, and the indications for these tests In general, the tests are relegated to the domain of the urologist, who will offer a variety of tests as per speci c patient indications
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marker of cardiovascular disease This topic is covered elsewhere in this textbook
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Laboratory Tests
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Most experts believe that certain laboratory tests are obligatory before treating ED In as much as the epidemiology suggests that men with ED may have diabetes or dyslipidemia, laboratory testing should follow that path
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Routine laboratory tests
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These should include a blood sugar and a fasting lipid pro le in all men with ED without a diagnosis of diabetes mellitus or dyslipidemia, respectively A PSA should be determined in the case of abnormal ndings during palpation of the prostate, or as per the physicians PSA screening protocol A urinalysis is also helpful to look for glucose, ketones and proteinuria, as well as blood and white blood cells Blood pressure, weight and waist circumference should be measured as a part of the ED evaluation, as ED has been linked to the metabolic syndrome Free testosterone, testosterone, prolactin and dehydroepiandrosterone sulfate (DHEAS) are the speci c hormones that may be part of the ED evaluation These hormones have been associated with sexual desire Luteinizing hormone (LH), folliclestimulating hormone (FSH) and sex hormonebinding globulin (SHBG) are determined for further differential diagnosis in the case of low testosterone values, to ascertain primary or secondary hypogonadism Estradiol, growth hormone or, better, insulin-like growth factor 1 (IGF-1) and thyroid parameters are determined in individual cases to diagnose further hormonal de cits It is recognized that serum testosterone levels decrease below the eugonadal range in some men with advancing age Restoration of testosterone levels to the eugonadal range (300 1000 ng/dL) appear to correct many of the clinical abnormalities (impaired sexual function, negative changes in body composition, etc) commonly associated with hypogonadism [24] With respect to hypogonadal males, a number of studies have demonstrated that testosterone replacement therapy can signi cantly affect a number of the fundamental indicators of apposite sexual
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Invasive Testing
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Intracavernous injection test combined with Doppler/duplex ultrasound
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This speci c diagnostic test in the hands of the urologist (or perhaps radiologist) should be thought of as an optional part of the evaluation It is the optimal method of reliably diagnosing relevant disturbed arterial blood supply to the penis, and of obtaining an approximate idea of the relaxation capacity and thus cavernous function in practice In addition, the
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Diagnosis of Erectile Dysfunction drug-induced erection reveals possible cavernous deformations in Peyronie s disease such as cavernous notches, or deviations that could themselves impair sexual intercourse [28,29] These anatomic changes of the corpus cavernosum or tunica albuginea, could be relevant in certain cases Many clinicians nd the expense of the Doppler/ duplex ultrasound cost prohibitive, and thus move to less costly devices The Knoll/MIDUS Ultrasound System serves to evaluate the penile blood ow after injection of a vasoactive agent such as PGE1 [30] While the type of ultrasound used may be left to the discretion of the clinician, it is clear that the ultrasound combined with the injection of a vasoactive agent provides a clear evaluation of the cavernosal arterial supply to the penis
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