Endocrinological testicular dysfunction in patients with lepromatous leprosy and the impact of disease on patient's quality of life

Hypogonadism and associated factors among male Leprosy patients

BACKGROUND

Leprosy affects various organs in addition to skin, eyes, and peripheral nerves. Testicular involvement in leprosy patients is common and causes disturbance in endocrine function of the testis and results in hypogonadism. Hypogonadism is frequently undiagnosed and underreported.

OBJECTIVE

This study aimed to assess hypogonadism and associated factors among leprosy patients at Alert Comprehensive Specialized Hospital, Ethiopia.

METHODS

A cross-sectional study design was used in which consecutive 146 male leprosy patients aged between 18 to 65 years attending outpatient follow-up at leprosy outpatient clinic were included. Data was gathered both from patient charts and through patients' interviews. Androgen deficiency symptoms were assessed by androgen deficiency in the aging male questionnaire, and 5ml of blood samples were taken from study participants and serum total testosterone, LH, and FSH were analyzed by Electrochemiluminescence method. Statistical correlation was assessed by Spearman correlation. A multivariable binary logistic regression model was used to identify the independent factors associated with hypogonadism and P-value <0.05 was used to declare statistical significance.

RESULTS

The prevalence of hypogonadism was 39 (26.7%). Out of this, 34 (87.2%) had primary hypogonadism, whereas 5 (12.8%) had secondary hypogonadism. Total testosterone was inversely correlated with Body mass index (r = -0.37, p = 0.002), Luteinizing hormone (r = -0.43, p <0.001), and Follicular stimulating hormone (r = -0.42, p< 0.001). However, Total testosterone was not significantly correlated with age (r = -0.019, p = 0.81). BMI [AOR = 1.32, 95%CI (1.16-1.51)] and grade-II disability [AOR = 3.80, 95%CI (1.23-11.64)] were identified as independent risk factors for hypogonadism.

CONCLUSION

Nearly one-fourth of male leprosy patients had hypogonadism. Overweight and grade-II disability were independent risk factors for hypogonadism.

Hansen's Disease: A Practical Update on a Neglected Globally Significant Infection

Leprosy is a great mimicker. It is caused by Mycobacterium leprae and Mycobacterium lepromatosis, together termed the M. leprae complex. Leprosy can result in systemic manifestations; however, the neurocutaneous syndrome is the most classic. There is a gap in recognizing the condition leading to misdiagnosis and delays in treatment. Leprosy remains an important cause of aesthetic and functional impairment. In this paper, we provide a practical review of leprosy touching on pathophysiology, clinical manifestation, classification, diagnostic approach and management of the condition in a way that can translate into clinical practice and help physicians better identify and manage potential cases of leprosy.

Evaluation of Clinical, Hormonal and Ultrasound Parameters of Male Reproductive System in Leprosy: A Cross-Sectional Study

Background and Objectives

Testicular involvement in leprosy is neglected as it is insidious and silent, although it can have an impact on quality of life. Our study aimed at evaluating and estimating the frequency of the hormonal, radiological and clinical parameters in these patients.

Materials and Methods

A cross-sectional study was conducted including 31 male leprosy patients attending our OPD. After detailed clinical assessment, patients were subjected to ultrasonological with Doppler examination of the scrotum and hormonal evaluation by ELISA technique for serum follicle-stimulating hormone (FSH), luteinising hormone (LH) and total testosterone.

Results

Thirty-one patients were included with ages ranging from 19 to 54 with a mean of 34 years. Decreased libido (19.3%) was significantly observed in the abnormal FSH (P < 0.01) and testosterone (P < 0.01) groups. The majority of the clinical findings such as erectile dysfunction, infertility and altered pubic hair pattern were seen in the lepromatous spectrum. Six (19.6%) patients had increased LH and FSH. Twenty-three (74%) had testicular atrophy (<12 ml) as assessed by USG. There was a significant association between the bilateral decreased testicular volumes (TVs) and FSH (P = 0.016 on the left and P < 0.01 on the right). Four of 31 patients had altered testicular echo texture of which two belong to the BL spectrum. The increase in the resistive index (RI) corresponded significantly to the decreased TV (P < 0.01) albeit on the left side only.

Conclusion

A sizeable proportion (74%) of the study sample had testicular atrophy. The significant association between increased RI and testicular atrophy, especially in patients with infertility, emphasises the ancillary role of Doppler indices in methodical diagnosis. Risk factors noted in the study include increased bacillary index, delayed initiation of treatment and recurrent ENL. Early detection, early initiation of MDT and specific therapies such as testosterone replacement can help improve the quality of life.

A Quality of Life Study in Patients with Leprosy Using DLQI and WHOQOL-BREF Questionnaires

CONTEXT

India accounts for 60% of the global leprosy burden. Deformities lead to a negative impact on the quality of life (QoL). There is a paucity of Indian studies evaluating the QoL in patients with leprosy.

AIMS

This study was undertaken to assess QoL in leprosy patients with two different questionnaires, correlate QoL with demographic and clinical profile and evaluate the impact on health-related QoL scores.

SETTINGS AND DESIGN

A cross-sectional study to evaluate the QoL was conducted in the dermatology OPD of a tertiary center in Maharashtra, India.

MATERIALS AND METHODS

Demographic and clinical profile along with evaluation of QoL using DLQI and WHOQOL-BREF questionnaires was conducted in 60 leprosy patients.

STATISTICAL ANALYSIS USED

Parametric test, R test, Chi-square test, Z test, Student's t-test (t), and Pearson's correlation coefficient (r) were used.

RESULTS

The mean DLQI score was 8.4 ± 4.4 and 40% of patients had moderate impact on QoL, and the mean WHOQOL-BREF score was 3.13 ± 0.9. The demographic profile, type of leprosy and reactions did not have a statistically significant correlation with DLQI. Presence of deformity had significant impact on DLQI and a statistically significant impact on physical, psychological, and environmental domain in WHOQOL-BREF analysis.

CONCLUSIONS

Deformities have a profound impact on QoL in leprosy patients on evaluation with DLQI and WHOQOL- BREF questionnaires. The social domain was least affected, whereas severe impact was noted in psychological domain. DLQI is a practical and simple questionnaire, whereas WHOQOL- BREF provides a comprehensive approach on all domains.