Echocardiographic evaluation of left ventricular mass index in children with hypospadias after hormonal stimulation with topical testosterone: A randomized controlled trial.

Autor: de Andrade EC; Department of Pediatrics, Federal University of Juiz de Fora, UFJF, Brazil., de Castro Paiva KC; Department of Pediatrics, Federal University of Juiz de Fora, UFJF, Brazil., da Silva Guedes S; Department of Pediatrics, Federal University of Juiz de Fora, UFJF, Brazil., Souza MLC; Department of Pediatrics, Federal University of Juiz de Fora, UFJF, Brazil., Pereira MN; Department of Pediatrics, Federal University of Juiz de Fora, UFJF, Brazil., Miana LP; Department of Pediatrics, Federal University of Juiz de Fora, UFJF, Brazil., de Figueiredo AA; Department of Surgery, Division of Urology, Federal University of Juiz de Fora, UFJF, Brazil., de Bessa J Jr; Department of Surgery, Division of Urology, State University of Feira de Santana, UEFS, Brazil., Netto JMB; Department of Surgery, Division of Urology, Federal University of Juiz de Fora, UFJF, Brazil; Department of Surgery, Division of Urology, Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Suprema, Brazil. Electronic address: jose.murillo@ufjf.edu.br.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2017 Aug; Vol. 13 (4), pp. 352.e1-352.e7. Date of Electronic Publication: 2017 Apr 10.
DOI: 10.1016/j.jpurol.2017.03.019
Abstrakt: Introduction: Testosterone is often used in the preoperative period of hypospadias surgery. Previous studies have demonstrated the presence of androgen receptors in cardiac myocytes that can modulate the phenotype. The use of supraphysiological doses of androgens can lead to toxicity on the heart muscle and, in some cases, to left ventricular hypertrophy. This randomized double blind controlled clinical trial aims to evaluate the effect of topical testosterone on left ventricular mass index in boys with hypospadias.
Materials and Methods: Boys with hypospadias aged 6 months to 9 years were included. Children were divided into two groups: G1 - boys who received testosterone propionate 1% ointment twice a day for 30 days, and G2 - boys receiving placebo ointment in the same regimen. All children were submitted to bi-dimensional echocardiographic evaluation to compare the left ventricular mass index, blood pressure, and body mass index before and after treatment (30 and 90 days). Levels of serum testosterone, LH, and FSH were measured.
Results: Thirty-five children were analyzed: 17 in G1 and 18 in G2. No differences were found in left ventricular mass index (left ventricular mass indexed by body surface area) prior to treatment. Left ventricular mass index was 59.21 ± 11.91 g/m 2 in G1 and 55.12 ± 8.29 g/m 2 in G2 (p = 0.244) after 30 days of treatment, and 61.13 ± 11.69 g/m 2 in G1 and 62.84 ± 35.99 g/m 2 in G2 (p = 0.852) after 90 days. Serum testosterone levels were 12 (7-80) ng/dL in G1 and 5 (5-7) ng/dL in G2 (p = 0.018) after 30 days of treatment, and 10 (5-11) ng/dL in G1 and 5 (4-5) ng/dL in G2 (p = 0.155), after 90 days (Figure). There was a small increase in systolic blood pressure (SBP) after 30 days (83.82 ± 7.18 mmHg) in the group who receive testosterone (G1) compared with controls (77.5 ± 6.69 mmHg) (p = 0.010). After 90 days, SBP levels returned to basal levels in G1 (82.35 ± 5.62 mmHg) and in G2 (81.38 ± 4.79 mmHg) (p = 0.588).
Conclusion: Topical testosterone can be considered safe in the preoperative period of children with hypospadias with no risk of left ventricular hypertrophy. An increase in systolic blood pressure occurs while using testosterone but it is transitory, returning to normal levels after 90 days.
(Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: