Abnormalities in Estrogen, Androgen, and Insulin Metabolism in Idiopathic Hemochromatosis^a

Abstract

Of 44 male patients with idiopathic hemochromatosis who were diagnosed at an early stage without morphological or biochemical evidence of liver disease, 25% suffered from impotence and 34% manifested glucose intolerance. Impotence was correlated with a 50% reduction in plasma testosterone, resulting from a 63% decrease in testosterone production. Testicular atrophy was caused by insufficient secretion of gonadotropins due to the selective accumulation of iron in gonadotropic cells of the pituitary gland. However, peripheral sexual hormone metabolism, in particular the conversion of androgens to estrogens, remained unaltered. It was therefore possible to employ substitution therapy successfully with testosterone in these men, and hyperestrogenism was not observed as a side effect. The pathogenetic factors in the development of diabetes mellitus in patients with idiopathic hemochromatosis include impaired insulin secretion caused by the selective deposition of iron in B-cells of the pancreas and insulin resistance due to iron accumulation in the liver. In particular, the insulin resistance is markedly improved after depletion of body iron stores by phlebotomy treatment, resulting in lower insulin requirements in patients with insulin-dependent diabetes as well as improvement of carbohydrate metabolisms in about half of the patients with non-insulin-dependent diabetes. We have concluded that hypogonadism and carbohydrate intolerance are caused by the specific distribution pattern of excess iron in the organism, accompanied by functional impairment of affected parenchymal cells.

Levels of estradiol and testosterone are altered in Chinese men with sexual dysfunction

“…Given adipose tissue is a crucial source of aromatization of testosterone, obesity should be a certain cause of hyperestrogenism. In addition, endogenous E 2 -T ratio increase is a clinical characteristic of several conditions, including chronic liver diseases, type II diabetes mellitus, hypercholesterolemia, Klinefelter syndrome, and tumors of Leydig cells or adrenal cortex (Mineur et al, 1987;Stremmel et al, 1988;Oettel, 2002). Exogenous factors that affect E 2 -T homeostasis include various environmental agents and plant estrogens, such as xenoestrogens and phytoestrogen (Oliva et al, 2002;Srilatha & Adaikan, 2004).…”

Hämochromatose und Morbus Wilson

“…Neben der Komponente der eingeschränkten Insulinsekretion besteht bei der Hämochromatose eine fast obligate Insulinresistenz [36], die jedoch -im Gegensatz zur Zerstörung der B-Zellen -nach erfolgreicher Aderlaßtherapie oft reversibel ist.…”

Endocrine milieu and erectile dysfunction: is oestradiol–testosterone imbalance, a risk factor in the elderly?

“…14 Other precipitating conditions of hyperestrogenism (and possible T deficiencies) include noninsulin-dependent diabetes mellitus, hypercholesterolaemia, chronic liver disorders, idiopathic haemochromatosis and tumours of male breast or Leydig cells. 13,[15][16][17] Obesity in males has been shown to be associated with low T levels, reduced spermatogenesis leading to infertility and a concomitant increase in the incidence of ED. 18 Correction of hormonal imbalance (with increased total and free T and reduced prolactin levels) in the morbidly obese, resulting from substantial weight loss, improved erectile function quality as measured by International Index of Erectile Function scores.…”