title: Liver iron overload is associated with elevated SHBG concentration and moderate hypogonadotrophic hypogonadism in dysmetabolic men without genetic haemochromatosis.
abstract: OBJECTIVE
  To assess the relation between moderate iron overload on sex hormone binding globulin (SHBG) levels and gonadotroph function in men with dysmetabolic iron overload syndrome and the effects of phlebotomy.
  
  
  METHODS
  The relationship between magnetic resonance imaging assessed liver iron concentration (LIC) and plasma ferritin levels with total testosterone, bioavailable testosterone (BT), SHBG and LH levels, were studied in 50 men with moderate dysmetabolic iron excess, in the absence of genetic haemochromatosis, who were randomised to phlebotomy therapy or to normal care.
  
  
  RESULTS
  Four patients (8%) had low total testosterone (<10.4 nmol/l) and 13 patients (26%) had low BT (<2.5 nmol/l). In the entire population, those with LIC above the median (90 μmol/l) had a higher mean SHBG (P=0.028), lower LH (P=0.039) than those with LIC below the median. In multivariable analysis (adjusted for age, and fasting insulin) LIC was significantly associated with SHBG (positively) and LH (negatively). Patients in the highest quartile of SHBG had higher LIC (P=0.010) and higher ferritinaemia (P=0.012) than those in the three other quartiles. Iron depletion by venesection did not significantly improve any hormonal levels.
  
  
  CONCLUSIONS
  Hypogonadism is not infrequent in men with dysmetabolic iron overload syndrome. Liver iron excess is associated with increased plasma SHBG and moderate hypogonadotrophic hypogonadism. Phlebotomy therapy needs further investigation in symptomatic hypogonadal men with dysmetabolic iron excess.
authors.affiliation: Service d'Endocrinologie, CHU de Rennes, Université Rennes 1, Hôpital Sud, 16 Boulevard de Bulgarie, 35203 Rennes, France. alain.gautier@chu-rennes.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Gautier
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lainé
authors.forename: Catherine
authors.initials: C
authors.lastname: Massart
authors.forename: Laure
authors.initials: L
authors.lastname: Sandret
authors.forename: Xavier
authors.initials: X
authors.lastname: Piguel
authors.forename: Pierre
authors.initials: P
authors.lastname: Brissot
authors.forename: Beverley
authors.initials: B
authors.lastname: Balkau
authors.forename: Yves
authors.initials: Y
authors.lastname: Deugnier
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D006432:Hemochromatosis / Q000235:genetics; D006801:Humans; D007006:Hypogonadism / Q000097:blood* / Q000150:complications / Q000378:metabolism; D019190:Iron Overload / Q000097:blood* / Q000150:complications / Q000628:therapy*; D008099:Liver / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008659:Metabolic Diseases / Q000097:blood* / Q000150:complications; D008875:Middle Aged; D009994:Osmolar Concentration; D018962:Phlebotomy; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D012738:Sex Hormone-Binding Globulin / Q000032:analysis* / Q000378:metabolism
chemical_list: D012738:Sex Hormone-Binding Globulin