Hypogonadism in the Prader-Willi syndrome from birth to adulthood: a 28-year experience in a single centre

Background: Hypogonadism is a key feature of Prader-Willi syndrome (PWS) but clear strategies for hormone replacement are lacking. Objective: To evaluate gonadal status and outcome in patients attending a Scottish PWS clinic from 1991-2019. Methods: In 93 (35F:56M) patients, median follow-up 11.2 years, gonadal and pubertal status were assessed clinically. Pelvic ultrasound findings and basal/stimulated gonadotrophins were compared with age-matched controls. Results: Females: Of 22 patients aged >11, 9 had reached B4-5, while 5 were still at B2-3, and 6 remained prepubertal. Eight patients experienced menarche aged 9.8-21.4 years, none with a normal cycle. Uterine length and ovarian volumes were normal but uterine configuration remained immature, with low follicular counts. Gonadotrophins were unremarkable, serum estradiol 129 (70 – 520) pmol/L. Only 5 patients received oestrogen replacement. Males: Fifty-four (96%) patients were cryptorchid (9 unilateral). Weekly hCG injections resulted in unilateral/bilateral descent in 2/1 of 25 patients. Of 37 boys aged >11, 14 (9 with failed/untreated bilateral cryptorchidism) failed to progress beyond G1, 15 arrested at G2-3 (testes 3-10 ml), and 8 reached G4-5. Gonadotrophins were unremarkable except in boys at G2-5 in whom FSH was elevated: 12.3/27.3 vs 3.25/6.26 U/L in controls (p<0.001). In males aged >13, testosterone was 3.1 (0.5-8.4) nmol/L. Androgen therapy, given from 13.5-29.2 years, was stopped in 4/24 patients owing to behavioural problems. Conclusion: Despite invariable hypogonadism, few females and only half the males with PWS in this study received hormone replacement. Double-blind placebo-controlled crossover trials of sex steroids are required to address unproven behavioural concerns.

The importance of SHBG and calculated free testosterone for the diagnosis of symptomatic hypogonadism in HIV-infected men: a single-centre real-life experience

Purpose The prevalence of low testosterone and symptoms of hypogonadism in HIV-infected men is still debated. We aimed to estimate the prevalence and type of hypogonadism in HIV-infected males complaining about sexual symptoms, and to evaluate the role of calculated free testosterone (cFT) vs total testosterone (TT) for diagnosis. Furthermore, we evaluated relationship between sex hormone-binding globulin (SHBG), gonadal status and clinical and virologic parameters. Methods We retrospectively evaluated 169 HIV-infected men with sexual symptoms, with TT available. Among them, we selected 94 patients with TT, SHBG, cFT, and luteinizing hormone (LH) available, and classified hypogonadism into overt (low TT and/or low cFT) and compensated (high LH, normal TT and cFT). Comparison was performed by non-parametric Kruskal–Wallis test and Spearman’s correlation was calculated to verify the possible associations. Results Overt and compensated hypogonadism were found in 20.2% and 13.8% of patients, respectively. With reliance on TT alone, only 10.6% of patients would have met diagnosis. SHBG values were elevated in one third of patients, and higher in men with compensated hypogonadism. Significant positive correlation was found between SHBG and HIV infection duration, TT and LH. Conclusion Only a complete hormonal profile can properly diagnose and classify hypogonadism in HIV-infected men complaining about sexual symptoms. TT alone reliance may lead to half of diagnoses missing, while lack of gonadotropin prevents the identification of compensated hypogonadism. This largely comes from high SHBG, which seems to play a central role in the pathogenesis of hypogonadism in this population.

Impact of gonadal status on ultrasonographic renal parenchymal dimensions in healthy cats

Objectives The aim of this study was to evaluate the effect of gonadal status on ultrasonographic renal parenchymal dimensions in healthy cats. Methods Forty healthy cats (10 intact males, 10 intact females, 10 castrated males and 10 spayed females) presented to the Division of Obstetrics, Gynecology and Reproduction, and the Diagnostic Imaging Unit at The Small Animal Teaching Hospital, Faculty of Veterinary Science, Chulalongkorn University. They were ultrasonographically examined to assess renal length, aortic luminal diameter, cortical thickness and medullary thickness. Results Regardless of gonadal status, the renal length, aortic luminal diameter, cortical thickness and medulla thickness of males were greater than those of females ( P <0.05). In general, neutered cats had thicker medullae (0.36 ± 0.08 cm) and higher mean renal length:aortic luminal diameter ratio (12.15 ± 1.48) than intact cats (0.32 ± 0.08 cm and 11.22 ± 1.37 cm, respectively) ( P <0.05), but no differences were observed in renal length, cortical thickness or aortic luminal diameter. Interestingly, when comparing between sexes with relatively equal body weight, only sex had an impact on renal length. Conclusions and relevance Gonadal status has an effect on medullary thickness and mean renal length:aortic luminal diameter ratio.

Influence of Housing Conditions on Reliability of Immunocastration and Consequences for Growth Performance of Male Pigs

Immunocastration is a sustainable alternative to piglet castration but faces limited market acceptance. The phenomenon of non-responders has not to date been examined in detail, but adverse and stressful housing conditions (e.g., mixing of groups) might impair the success of vaccinations. Therefore, we evaluated the influence of housing conditions on the immune response after two Improvac® vaccinations at an age of 12 and 22 weeks, respectively. Boars, immunocastrates and barrows (n = 48 each) were assigned to three different housing conditions (n = 36 enriched, n = 36 standard n = 72 repeated social mixing). Immune response was quantified by measuring GnRH-binding and its consequences for testosterone concentrations, development of the genital tract and boar taint. Growth performance was evaluated via average daily gain (ADG). GnRH-binding and testosterone levels revealed that immunocastration reliably suppressed testicular functions after the 2nd vaccination. Housing conditions did not modify testicular function but influenced ADG as animals under mixing grew slower than those under enriched conditions. Gonadal status had only a slight impact on ADG except in immunocastrates, which showed a temporarily higher ADG after the 2nd vaccination. The results show that immunocastration is a reliable procedure under different housing conditions and competitive in terms of growth performance.

FTO and IRX3 Genes are Not Promising Markers for Obesity in Labrador Retriever Dogs

Obesity is a serious problem in numerous dog breeds, but knowledge of its hereditary background is scarce. On the contrary, numerous DNA polymorphisms associated with human obesity have been identified, with the strongest effect being demonstrated for FTO gene. We used targeted next-generation sequencing (tNGS) to search for polymorphisms in the region harboring FTO and IRX3 in 32 Labrador dogs. Moreover, we investigated the selected regions of FTO and IRX3, orthologous to the human regions associated with obesity, in 165 Labradors. For all dogs, the following information was available: age, sex, gonadal status, body weight, and body conformation score (BCS). The use of tNGS revealed 12,217 polymorphisms, but none of these obtained significance when lean and obese dogs were compared. Study of two SNPs in the 5’-flanking region of FTO in 165 dogs – creating two upstream reading frames (uORFs) – also showed no association with body weight and BCS but suggested the need for improvement in FTO annotation. No polymorphism was found in the 5’UTR of IRX3. Additionally, no differences of CpG islands methylation status between lean and obese dogs were found. Our study suggests that FTO and IRX3 are not useful markers of obesity in Labrador dogs.