Q: 64 years old health-conscious man is admitted to ICU with Pulmonary Embolism (PE). Few weeks ago, patient was started on Testosterone therapy after his insistence to increase his prowess at the gym. Which of the underlying disease need to be ruled out?
Answer: Thrombophilia-hypofibrinolysis
Unfortunately, in the last few years, there is an epidemic of exogenous Testosterone replacement even in normal healthy individuals. Multiple studies are now showing increased prevalence of ICU admissions due to Deep Venous Thrombosis (DVT) and PE in otherwise healthy patients. ICU clinicians need to rule out such inappropriate use.
There are two major causes described for thromboembolism in patients who have been treated with exogenous testosterone therapy. 1) Erythrocytosis 2) Thrombophilia-hypofibrinolysis.
Testosterone should be stopped if hematocrit is above 54 percent. Most patients with underlying but undiagnosed thrombophilia-hypofibrinolysis develop DVT and PE within three months of starting the therapy. There is a complex interaction between familial and acquired thrombophilia and exogenous hormone use.
#endocrinology
References:
1. Ponce OJ, Spencer-Bonilla G, Alvarez-Villalobos N, et al. The efficacy and adverse events of testosterone replacement therapy in hypogonadal men: A systematic review and meta-analysis of randomized, placebo-controlled trials.
No comments:
Post a Comment