The metabolic syndrome and disturbances in hormone levels in long-term survivors of disseminated testicular cancer.
OBJECTIVE
The metabolic syndrome may be an important risk factor for cardiovascular disease in long-term survivors of testicular cancer (TC). We investigated the associations between hormone levels and the metabolic syndrome in these men.


METHODS
We included TC patients cured by orchidectomy and cisplatin-based chemotherapy, stage I TC patients after orchidectomy only, and healthy men of comparable age. Presence of the metabolic syndrome was determined using guidelines from the National Cholesterol Education Program Adult Treatment Panel III. Thyroid-stimulating hormone, follicle-stimulating hormone (FSH), inhibin B, luteinizing hormone (LH), total testosterone, sex-hormone-binding globulin, free testosterone, estradiol, dehydroepiandrosterone sulfate, and insulin-like growth factor 1 were determined in blood. Cortisol metabolite excretion was measured in urine.


RESULTS
Eighty-six chemotherapy patients (median follow-up, 7 years) were compared with 44 stage I patients and 47 controls. LH and FSH were higher, and inhibin B and total and free testosterone were lower in chemotherapy patients than controls. Adrenal and thyroid hormone production were unaffected. Chemotherapy patients with the metabolic syndrome (n = 22; 26%) had a higher body mass index (BMI) pretreatment, a larger BMI increase during follow-up, lower total testosterone, and higher urinary cortisol metabolite excretion than those patients without the metabolic syndrome. BMI and insulin were associated with the metabolic syndrome, while total testosterone and urinary cortisol metabolite excretion were associated with BMI.


CONCLUSIONS
We found gonadal dysfunction, but normal adrenal and thyroid function. Through its association with BMI, testosterone may play a role in the development of the metabolic syndrome in long-term TC survivors.
Nuver
Janine
J
Department of Medical Oncology, University Hospital Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, the Netherlands.
Smit
Andries J
AJ
Wolffenbuttel
Bruce H R
BH
Sluiter
Wim J
WJ
Hoekstra
Harald J
HJ
Sleijfer
Dirk T
DT
Gietema
Jourik A
JA
D000328:Adult; D000368:Aged; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood*; D008875:Middle Aged; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism*; D017741:Survivors; D013736:Testicular Neoplasms / Q000097:blood*; D013739:Testosterone / Q000097:blood*; D013997:Time Factors
D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone