Prevalence and influence of diagnostic criteria in the assessment of hypogonadism in intrathecal opioid therapy patients

Rui Duarte; Jon H. Raphael; Mourad Labib; Jane L. Southall; Robert L. Ashford

Prevalence and influence of diagnostic criteria in the assessment of hypogonadism in intrathecal opioid therapy patients

Rui Duarte, Jon H. Raphael, Mourad Labib, Jane L. Southall, Robert L. Ashford

Research output: Contribution to journal › Article › peer-review

19 Citations (Scopus)

Abstract

Background: Hypogonadism is frequently diagnosed based on total testosterone (TT) levels alone. However, 99% of testosterone is bound to the sex hormone-binding globulin (SHBG) with only 1% free testosterone. Alternative assessment methods consist of assay of free testosterone (FT) or bioavailable testosterone (BT) by equilibrium dialysis, calculation of FT and BT through the Vermeulen equations, and calculation of the free androgen index (FAI). Objectives: The aim of this study was to investigate the prevalence of hypogonadism in male chronic non-cancer pain patients undertaking long-term intrathecal opioid therapy and the existence of diagnostic discrepancies according to the criteria used. Study design: Prospective observational study. Setting: Department of Pain Management, Russells Hall Hospital, Dudley, United Kingdom. Methods: Twenty consecutive male patients undertaking long-term intrathecal opioid therapy had the gonadal axis evaluated by assays of luteinising hormone (LH), follicle stimulating hormone (FSH), TT, SHBG and by calculating the FT, BT and FAI. Results: Hypogonadism was present in 17 (85%) of the patients based on TT; 17 (85%) according to FT and BT calculations; and 14 (70%) when calculating FAI. Based on either TT or FT being low or borderline/low, 19 (95%) of the investigated patients were biochemically hypogonadal. Significant differences were observed between diagnosis based on FT and FAI (P < 0.05). No significant differences were observed between diagnosis based on TT and FT (P = 0.40) or TT and FAI (P = 0.20). Conclusion: Hypogonadism is common in patients undertaking intrathecal opioid therapy for the management of chronic non-malignant pain; however, diagnostic criteria can influence the diagnosis of this side effect. The assessment of the hypothalamic-pituitarygonadal axis should include evaluation of total serum testosterone, free testosterone, or bioavailable testosterone.

Original language	English
Pages (from-to)	9-14
Number of pages	6
Journal	Pain physician
Volume	16
Issue number	1
Publication status	Published - Jan 2013
Externally published	Yes

Keywords

Diagnostic criteria
Free testosterone
Hypogonadism
Implantable drug delivery systems
Total serum testosterone

ASJC Scopus subject areas

Anesthesiology and Pain Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Cite this

@article{e91e28812a4a405eb6b2c863016b5aaa,

title = "Prevalence and influence of diagnostic criteria in the assessment of hypogonadism in intrathecal opioid therapy patients",

abstract = "Background: Hypogonadism is frequently diagnosed based on total testosterone (TT) levels alone. However, 99% of testosterone is bound to the sex hormone-binding globulin (SHBG) with only 1% free testosterone. Alternative assessment methods consist of assay of free testosterone (FT) or bioavailable testosterone (BT) by equilibrium dialysis, calculation of FT and BT through the Vermeulen equations, and calculation of the free androgen index (FAI). Objectives: The aim of this study was to investigate the prevalence of hypogonadism in male chronic non-cancer pain patients undertaking long-term intrathecal opioid therapy and the existence of diagnostic discrepancies according to the criteria used. Study design: Prospective observational study. Setting: Department of Pain Management, Russells Hall Hospital, Dudley, United Kingdom. Methods: Twenty consecutive male patients undertaking long-term intrathecal opioid therapy had the gonadal axis evaluated by assays of luteinising hormone (LH), follicle stimulating hormone (FSH), TT, SHBG and by calculating the FT, BT and FAI. Results: Hypogonadism was present in 17 (85%) of the patients based on TT; 17 (85%) according to FT and BT calculations; and 14 (70%) when calculating FAI. Based on either TT or FT being low or borderline/low, 19 (95%) of the investigated patients were biochemically hypogonadal. Significant differences were observed between diagnosis based on FT and FAI (P < 0.05). No significant differences were observed between diagnosis based on TT and FT (P = 0.40) or TT and FAI (P = 0.20). Conclusion: Hypogonadism is common in patients undertaking intrathecal opioid therapy for the management of chronic non-malignant pain; however, diagnostic criteria can influence the diagnosis of this side effect. The assessment of the hypothalamic-pituitarygonadal axis should include evaluation of total serum testosterone, free testosterone, or bioavailable testosterone.",

keywords = "Diagnostic criteria, Free testosterone, Hypogonadism, Implantable drug delivery systems, Total serum testosterone",

author = "Rui Duarte and Raphael, {Jon H.} and Mourad Labib and Southall, {Jane L.} and Ashford, {Robert L.}",

year = "2013",

month = jan,

language = "English",

volume = "16",

pages = "9--14",

journal = "Pain physician",

issn = "1533-3159",

publisher = "Association of Pain Management Anesthesiologists",

number = "1",

}

TY - JOUR

T1 - Prevalence and influence of diagnostic criteria in the assessment of hypogonadism in intrathecal opioid therapy patients

AU - Duarte, Rui

AU - Raphael, Jon H.

AU - Labib, Mourad

AU - Southall, Jane L.

AU - Ashford, Robert L.

PY - 2013/1

Y1 - 2013/1

N2 - Background: Hypogonadism is frequently diagnosed based on total testosterone (TT) levels alone. However, 99% of testosterone is bound to the sex hormone-binding globulin (SHBG) with only 1% free testosterone. Alternative assessment methods consist of assay of free testosterone (FT) or bioavailable testosterone (BT) by equilibrium dialysis, calculation of FT and BT through the Vermeulen equations, and calculation of the free androgen index (FAI). Objectives: The aim of this study was to investigate the prevalence of hypogonadism in male chronic non-cancer pain patients undertaking long-term intrathecal opioid therapy and the existence of diagnostic discrepancies according to the criteria used. Study design: Prospective observational study. Setting: Department of Pain Management, Russells Hall Hospital, Dudley, United Kingdom. Methods: Twenty consecutive male patients undertaking long-term intrathecal opioid therapy had the gonadal axis evaluated by assays of luteinising hormone (LH), follicle stimulating hormone (FSH), TT, SHBG and by calculating the FT, BT and FAI. Results: Hypogonadism was present in 17 (85%) of the patients based on TT; 17 (85%) according to FT and BT calculations; and 14 (70%) when calculating FAI. Based on either TT or FT being low or borderline/low, 19 (95%) of the investigated patients were biochemically hypogonadal. Significant differences were observed between diagnosis based on FT and FAI (P < 0.05). No significant differences were observed between diagnosis based on TT and FT (P = 0.40) or TT and FAI (P = 0.20). Conclusion: Hypogonadism is common in patients undertaking intrathecal opioid therapy for the management of chronic non-malignant pain; however, diagnostic criteria can influence the diagnosis of this side effect. The assessment of the hypothalamic-pituitarygonadal axis should include evaluation of total serum testosterone, free testosterone, or bioavailable testosterone.

AB - Background: Hypogonadism is frequently diagnosed based on total testosterone (TT) levels alone. However, 99% of testosterone is bound to the sex hormone-binding globulin (SHBG) with only 1% free testosterone. Alternative assessment methods consist of assay of free testosterone (FT) or bioavailable testosterone (BT) by equilibrium dialysis, calculation of FT and BT through the Vermeulen equations, and calculation of the free androgen index (FAI). Objectives: The aim of this study was to investigate the prevalence of hypogonadism in male chronic non-cancer pain patients undertaking long-term intrathecal opioid therapy and the existence of diagnostic discrepancies according to the criteria used. Study design: Prospective observational study. Setting: Department of Pain Management, Russells Hall Hospital, Dudley, United Kingdom. Methods: Twenty consecutive male patients undertaking long-term intrathecal opioid therapy had the gonadal axis evaluated by assays of luteinising hormone (LH), follicle stimulating hormone (FSH), TT, SHBG and by calculating the FT, BT and FAI. Results: Hypogonadism was present in 17 (85%) of the patients based on TT; 17 (85%) according to FT and BT calculations; and 14 (70%) when calculating FAI. Based on either TT or FT being low or borderline/low, 19 (95%) of the investigated patients were biochemically hypogonadal. Significant differences were observed between diagnosis based on FT and FAI (P < 0.05). No significant differences were observed between diagnosis based on TT and FT (P = 0.40) or TT and FAI (P = 0.20). Conclusion: Hypogonadism is common in patients undertaking intrathecal opioid therapy for the management of chronic non-malignant pain; however, diagnostic criteria can influence the diagnosis of this side effect. The assessment of the hypothalamic-pituitarygonadal axis should include evaluation of total serum testosterone, free testosterone, or bioavailable testosterone.

KW - Diagnostic criteria

KW - Free testosterone

KW - Hypogonadism

KW - Implantable drug delivery systems

KW - Total serum testosterone

UR - http://www.scopus.com/inward/record.url?scp=84872818832&partnerID=8YFLogxK

M3 - Article

C2 - 23340538

AN - SCOPUS:84872818832

SN - 1533-3159

VL - 16

SP - 9

EP - 14

JO - Pain physician

JF - Pain physician

IS - 1

ER -

Prevalence and influence of diagnostic criteria in the assessment of hypogonadism in intrathecal opioid therapy patients

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Fingerprint

Cite this