Abstract：
BACKGROUND: Hypogonadism may be caused by Cushing syndrome (CS) and may intensify its adverse consequences.
OBJECTIVE: To determine the frequency of male hypogonadism before and after curative surgery for CS, and its cause.
METHODS: Post-hoc analyses of prospective cohort studies.
METHODS: Clinical research center.
METHODS: Men with ACTH-dependent CS. Cohort 1 (C1) (n=8, age 32.5±12 y; studied 1985-1989); Cohort 2 (C2) (n=44, 42.7 ± 15.1 y; studied 1989-2021).
METHODS: C1: Every 20-minute blood sampling for 24h before and 1-40 months after surgical cure. Three subjects underwent GnRH stimulation tests pre- and post-surgery. C2: Hormone measurements at baseline and 6 and 12 months (M) post-cure.
METHODS: C1: LH, FSH, LH pulse frequency and LH response to GnRH. C2: LH, FSH, testosterone (T), free T, fT4, T3, TSH and UFC levels and frequency of hypogonadism pre- and post-surgery.
RESULTS: C1: mean LH and LH pulse frequency increased after surgery (p < 0.05) without changes in LH pulse amplitude, mean FSH, or peak gonadotropin response to GnRH. C2: 82% had baseline hypogonadism (total T 205 ± 28 ng/dL). Thyroid hormone levels varied inversely with UFC and cortisol. LH, total and free T, and SHBG increased at 6M and 12M post surgery, but hypogonadism persisted in 51% at 6M and in 26% at 12M.
CONCLUSIONS: Hypogonadism in men with CS is widely prevalent but reversible in ∼75% of patients one year after surgical cure and appears to be mediated through suppression of hypothalamic GnRH secretion, and modulated by thyroid hormones.
OBJECTIVE: To determine the frequency of male hypogonadism before and after curative surgery for CS, and its cause.
METHODS: Post-hoc analyses of prospective cohort studies.
METHODS: Clinical research center.
METHODS: Men with ACTH-dependent CS. Cohort 1 (C1) (n=8, age 32.5±12 y; studied 1985-1989); Cohort 2 (C2) (n=44, 42.7 ± 15.1 y; studied 1989-2021).
METHODS: C1: Every 20-minute blood sampling for 24h before and 1-40 months after surgical cure. Three subjects underwent GnRH stimulation tests pre- and post-surgery. C2: Hormone measurements at baseline and 6 and 12 months (M) post-cure.
METHODS: C1: LH, FSH, LH pulse frequency and LH response to GnRH. C2: LH, FSH, testosterone (T), free T, fT4, T3, TSH and UFC levels and frequency of hypogonadism pre- and post-surgery.
RESULTS: C1: mean LH and LH pulse frequency increased after surgery (p < 0.05) without changes in LH pulse amplitude, mean FSH, or peak gonadotropin response to GnRH. C2: 82% had baseline hypogonadism (total T 205 ± 28 ng/dL). Thyroid hormone levels varied inversely with UFC and cortisol. LH, total and free T, and SHBG increased at 6M and 12M post surgery, but hypogonadism persisted in 51% at 6M and in 26% at 12M.
CONCLUSIONS: Hypogonadism in men with CS is widely prevalent but reversible in ∼75% of patients one year after surgical cure and appears to be mediated through suppression of hypothalamic GnRH secretion, and modulated by thyroid hormones.
摘要：
背景：性腺功能减退可能由库欣综合征（CS）引起，并可能加剧其不良后果。
目的：为了确定男性性腺功能减退症在CS治愈性手术前后的频率，和它的原因。
方法：前瞻性队列研究的事后分析。
方法：临床研究中心。
方法：患有ACTH依赖性CS的男性。队列1(C1)(n=8，年龄32.5±12岁；1985-1989年研究)；队列2(C2)(n=44，42.7±15.1岁；1989-2021年研究)。
方法：C1：手术治愈前24小时和手术治愈后1-40个月，每20分钟采血一次。三名受试者在手术前后接受了GnRH刺激测试。C2:在基线和固化后6和12个月(M)的激素测量。
方法：C1：LH，FSH,LH脉冲频率和LH对GnRH的响应。C2:LH,FSH,睾酮（T），自由T,fT4，T3，TSH和UFC水平以及手术前后性腺功能减退的频率。
结果：C1：术后平均LH和LH脉冲频率增加（p<0.05），而LH脉冲振幅无变化，平均FSH，或对GnRH的促性腺激素反应峰值。C2:82%有基线性腺功能减退症(总T205±28ng/dL)。甲状腺激素水平与UFC和皮质醇成反比。LH,总T和自由T，SHBG在手术后6M和12M增加，但是性腺机能减退在6M时持续存在51％，在12M时持续存在26％。
结论：男性CS患者性腺功能减退症广泛流行，但在手术治愈一年后约有75％的患者是可逆的，并且似乎是通过抑制下丘脑GnRH分泌介导的，并由甲状腺激素调节。
目的：为了确定男性性腺功能减退症在CS治愈性手术前后的频率，和它的原因。
方法：前瞻性队列研究的事后分析。
方法：临床研究中心。
方法：患有ACTH依赖性CS的男性。队列1(C1)(n=8，年龄32.5±12岁；1985-1989年研究)；队列2(C2)(n=44，42.7±15.1岁；1989-2021年研究)。
方法：C1：手术治愈前24小时和手术治愈后1-40个月，每20分钟采血一次。三名受试者在手术前后接受了GnRH刺激测试。C2:在基线和固化后6和12个月(M)的激素测量。
方法：C1：LH，FSH,LH脉冲频率和LH对GnRH的响应。C2:LH,FSH,睾酮（T），自由T,fT4，T3，TSH和UFC水平以及手术前后性腺功能减退的频率。
结果：C1：术后平均LH和LH脉冲频率增加（p<0.05），而LH脉冲振幅无变化，平均FSH，或对GnRH的促性腺激素反应峰值。C2:82%有基线性腺功能减退症(总T205±28ng/dL)。甲状腺激素水平与UFC和皮质醇成反比。LH,总T和自由T，SHBG在手术后6M和12M增加，但是性腺机能减退在6M时持续存在51％，在12M时持续存在26％。
结论：男性CS患者性腺功能减退症广泛流行，但在手术治愈一年后约有75％的患者是可逆的，并且似乎是通过抑制下丘脑GnRH分泌介导的，并由甲状腺激素调节。
