array:23 [ "pii" => "S2530016424001241" "issn" => "25300164" "doi" => "10.1016/j.endinu.2024.05.010" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "1499" "copyright" => "SEEN y SED" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Endocrinol Diabetes Nutr. 2024;71:348-54" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2530016424001204" "issn" => "25300164" "doi" => "10.1016/j.endinu.2024.05.007" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "1496" "copyright" => "SEEN y SED" "documento" => "article" "crossmark" => 1 "subdocumento" => "pgl" "cita" => "Endocrinol Diabetes Nutr. 2024;71:355-64" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Consensus document</span>" "titulo" => "Executive summary of the Spanish consensus for the diagnosis, management, and follow-up of primary hyperaldosteronism" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "355" "paginaFinal" => "364" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resumen ejecutivo del consenso español para el diagnóstico, el tratamiento y el seguimiento del hiperaldosteronismo primario" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2738 "Ancho" => 2667 "Tamanyo" => 727185 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagnosis of primary hyperaldosteronism. HTN, hypertension; SBP, systolic blood pressure; DBP, diastolic blood pressure; BP, blood pressure; PH, primary hyperaldosteronism; PAC, plasma aldosterone concentration; AVS, adrenal venous sampling; MRA, mineralocorticoid receptor antagonists; ACC, adrenocortical carcinoma.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Araujo-Castro, Paola Parra Ramírez, Felicia A. Hanzu" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Araujo-Castro" ] 1 => array:2 [ "nombre" => "Paola" "apellidos" => "Parra Ramírez" ] 2 => array:2 [ "nombre" => "Felicia A." "apellidos" => "Hanzu" ] 3 => array:1 [ "colaborador" => "On behalf the following medical Spanish societies: SEEN, SEC, SEN, SEMI, SERAM, SERVEI, SEQC(ML), AEC" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530016424001204?idApp=UINPBA00004N" "url" => "/25300164/0000007100000008/v1_202410040619/S2530016424001204/v1_202410040619/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S253001642400123X" "issn" => "25300164" "doi" => "10.1016/j.endinu.2024.05.008" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "1497" "copyright" => "The Authors" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Endocrinol Diabetes Nutr. 2024;71:340-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Exploring plantar pressure distribution in patients with newly diagnosed diabetes: Implications for foot ulcer prevention in an overweight Mexican population" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "340" "paginaFinal" => "347" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1587 "Ancho" => 2333 "Tamanyo" => 290767 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Peak PP distribution based on the type of diabetic neuropathy. <span class="elsevierStyleItalic">Abbreviations</span>: No DN, nondiabetic neuropathy present; LVS, loss of vibration sensation; LPS, loss of pressure sensation; MT, metatarsal region; MF, midfoot region. The figure shows the PPP values at the four indicated regions when each type of neuropathy is present.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francis Rojas-Torres, Héctor Infanzón-Talango, Ana Cristina García-Ulloa, Sergio Hernández-Jiménez, Gerardo Rodríguez-Reyes" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Francis" "apellidos" => "Rojas-Torres" ] 1 => array:2 [ "nombre" => "Héctor" "apellidos" => "Infanzón-Talango" ] 2 => array:2 [ "nombre" => "Ana Cristina" "apellidos" => "García-Ulloa" ] 3 => array:2 [ "nombre" => "Sergio" "apellidos" => "Hernández-Jiménez" ] 4 => array:2 [ "nombre" => "Gerardo" "apellidos" => "Rodríguez-Reyes" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S253001642400123X?idApp=UINPBA00004N" "url" => "/25300164/0000007100000008/v1_202410040619/S253001642400123X/v1_202410040619/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Prevalence of hypogonadism in men with and without chronic obstructive pulmonary disease: A cross-sectional study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "348" "paginaFinal" => "354" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Horacio Matías Castro, Pablo Knoblovits, Joaquin Maritano Furcada, Eduardo Luis De Vito, Sebastían Matias Suarez, Pablo Rene Costanzo" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Horacio Matías" "apellidos" => "Castro" "email" => array:1 [ 0 => "matias.castro@hospitalitaliano.org.ar" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pablo" "apellidos" => "Knoblovits" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Joaquin" "apellidos" => "Maritano Furcada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Eduardo Luis" "apellidos" => "De Vito" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Sebastían Matias" "apellidos" => "Suarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Pablo Rene" "apellidos" => "Costanzo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Pulmonology Department, Hospital Italiano de Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Andrology Section, Endocrinology, Metabolism and Nuclear Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Institute of Medical Research Alfredo Lanari, Faculty of Medicine, University of Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de hipogonadismo en hombres con y sin enfermedad pulmonar obstructiva cronica: estudio de corte transversal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 759 "Ancho" => 990 "Tamanyo" => 46024 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Prevalence of hypogonadism in men with and without COPD. The prevalence of hypogonadism was greater in COPD vs non-COPD men. Error bars represent the 95% confidence interval. COPD, chronic obstructive pulmonary disease; *chi-square test.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> with a global prevalence of 11.7%.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a> It often coexists with other diseases that have a negative impact on prognosis and health status.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">3</span></a> One such condition is hypogonadism.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a> Hypogonadism has been associated with: muscle weakness, obesity, a decline in forced expiratory volume in the first second (FEV<span class="elsevierStyleInf">1</span>), anemia, infertility, gynecomastia, osteoporosis, sexual dysfunction, decreased libido, and depression.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Former studies have reported varying prevalence rates of hypogonadism in men with COPD, from 22 up to 69%.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6,7</span></a> There is controversy regarding whether the prevalence of hypogonadism is higher in individuals with COPD vs the general population.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7–10</span></a> The prevalence of hypogonadism in COPD patients in Latin America is unknown.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The main objective of this study was to determine the prevalence of hypogonadism in men with COPD and compare it with that of men without COPD.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted an analytical cross-sectional study to compare the prevalence of hypogonadism in adult men with COPD to that of non-COPD men in an Argentine tertiary referral center from January 2018 through January 2019.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A consecutive sampling of COPD and non-COPD patients was obtained. A total of 193 men with COPD who attended the Pulmonology Service at Hospital Italiano de Buenos Aires for outpatient evaluation were assessed for eligibility. The study participants were included if they were men older than 40 years with a diagnosis of COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, and in a clinically stable condition (without exacerbation over the past 4 weeks). Exacerbation was defined as an acute worsening of respiratory symptoms (increased dyspnea, cough or sputum production). Individuals were excluded due to treatment with androgens, antiandrogens, ketoconazole, gonadotropin-releasing factor analogues, cimetidine, phenytoin, opioids, carbamazepine, chronic administration of systemic glucocorticoids, comorbidities that may cause a decrease in testosterone levels, acute disease or inability to perform the spirometry. After applying these criteria, 59 subjects were excluded from the study and 134 COPD patients were eventually enrolled.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In addition, a group of non-COPD men from the outpatient endocrinology service at the same hospital were enrolled. Subjects with a history of not smoking, COPD, respiratory symptoms, and without other pulmonary diseases were included. Exclusion criteria were the same ones as those for the COPD group. Seventy age-matched non-COPD men were eventually enrolled.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Data collected for each subject included clinical characteristics, demographics and comorbidities, the administration of the Clinical Androgen Deficiency in Aging Males (ADAM) questionnaire, and the body mass index (BMI). All COPD patients underwent post-bronchodilator spirometry.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Hormone studies</span><p id="par0040" class="elsevierStylePara elsevierViewall">Blood samples were drawn from 8:00 through 11:00 AM, following an 8-h fasting period. Total testosterone and sex hormone-binding globulin (SHBG) levels were measured by electrochemiluminescence (Cobas 801, Roche). Luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels were measured by chemiluminescence (Alinity, Abbott). Free testosterone was estimated by the Vermeulen method.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> Inter- and intra-assay coefficients of variation were as follows: total testosterone, ≤6% and 2.5%; SHBG, ≤4% and 1.9%; LH, 4.7% and 4.3%; FSH, 2.7 and 2.2%. Reference values were LH (2–12<span class="elsevierStyleHsp" style=""></span>mIU/mL); FSH (1–12<span class="elsevierStyleHsp" style=""></span>mIU/mL); SHBG (13–71<span class="elsevierStyleHsp" style=""></span>nmol/L); total testosterone (249.0–836.0<span class="elsevierStyleHsp" style=""></span>ng/dL); free testosterone (68.5–137.3<span class="elsevierStyleHsp" style=""></span>pg/mL). Decreased total and free testosterone levels were defined as values <300<span class="elsevierStyleHsp" style=""></span>ng/dL and <65<span class="elsevierStyleHsp" style=""></span>pg/mL, respectively. The presence of hyperprolactinemia and thyroid disease was ruled out.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Definition of hypogonadism</span><p id="par0045" class="elsevierStylePara elsevierViewall">Hypogonadism was defined as the presence of symptoms along with biochemical evidence of testosterone deficiency.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">12–14</span></a> The presence of symptoms was assessed using the ADAM questionnaire,<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> which is a self-administered 10-item questionnaire that is answered with yes or no (<a class="elsevierStyleCrossRef" href="#sec0080">see supplementary material 1</a>). The ADAM questionnaire was considered positive if the subject answered “yes” to questions 1 and 7 or, at least, to 3 other questions. The cut-off point used for total testosterone was 300<span class="elsevierStyleHsp" style=""></span>ng/dL based on recommendations given by the American Urological Association and the 5th percentile of the reference value for healthy, non-obese young men according to the Endocrine Society.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13,16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The study was conducted following the statement of ethical principles for medical research involving human subjects outlined in the Declaration of Helsinki and the Good Clinical Practice guidelines. Approval from Hospital Italiano de Buenos Aires Research Ethics Committee was obtained (No. 2413). All subjects signed a written informed consent form prior to being included in the study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Severity of COPD</span><p id="par0055" class="elsevierStylePara elsevierViewall">COPD severity was assessed through the degree of obstruction measured by FEV<span class="elsevierStyleInf">1</span> (%) in post-bronchodilator spirometry. COPD patients with FEV<span class="elsevierStyleInf">1</span> <50% were categorized as severe and those with FEV<span class="elsevierStyleInf">1</span> ≥50% as non-severe.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sample size</span><p id="par0060" class="elsevierStylePara elsevierViewall">Sample size was estimated based on the previously reported prevalence rate of hypogonadism of 26% in COPD (p1), and 10% in controls (p2).<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a> Taking into account a power of 80% (1<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">β</span>), a level of significance of 0.05 (<span class="elsevierStyleItalic">α</span>), and a COPD/non-COPD ratio of 2, the number of patients to be recruited was estimated at 140 for COPD patients and 70 for non-COPD patients.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Continuous variables were expressed as mean and standard deviation or as median and interquartile range depending on the observed distribution. Categorical variables were expressed as proportions. The estimated prevalence of hypogonadism was reported as absolute numbers for each frequency and their percentage with the corresponding 95% confidence interval (95%CI). The inter-group prevalence of hypogonadism was compared using the chi-square test. The inter-group prevalence ratio of hypogonadism and its 95% confidence interval were calculated. Inter-group differences in continuous variables were assessed using the <span class="elsevierStyleItalic">t</span>-test or the Wilcoxon test and the categorical variables were assessed using the chi-square test or Fisher's exact test, as appropriate. A multivariate logistic regression analysis was performed to evaluate the association between COPD and hypogonadism adjusting for potential confounders such as age, BMI, and type 2 diabetes mellitus. Relationships between BMI and total testosterone were studied using Spearman correlations coefficient (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">s</span>). Statistical significance was set at a <span class="elsevierStyleItalic">p</span>-value <0.05. All statistical analyses were performed using STATA software (Version 13).</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">A total of 134 men with stable COPD and 70 non-COPD men were included in the study. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 1</a> shows the patient enrollment flow chart.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Patients had a mean age of 68.3 years (SD, 6.6), a mean BMI of 28<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (SD, 6.6), and 17% were current smokers. No statistically significant differences were found in age, BMI, or the presence of type 2 diabetes mellitus between COPD and non-COPD patients. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the clinical characteristics and testosterone levels of the enrolled patients.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The prevalence of hypogonadism was higher in COPD than in non-COPD patients (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 2</a>), with a prevalence ratio of 4.20 (95%CI, 2.0–8.7; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). COPD patients exhibited lower levels of total testosterone (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 3</a>) and free testosterone (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) vs non-COPD patients. The prevalence of low total testosterone concentrations was significantly higher in COPD vs non-COPD patients (47.0% vs 15.7%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><0.001). No inter-group differences in SHBG values were reported (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). A total of 70.2% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>94/134) of COPD patients had low free testosterone concentrations.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 32.1% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>43) of patients had severe COPD (FEV<span class="elsevierStyleInf">1</span> <50%). The prevalence of hypogonadism was higher in severe COPD patients vs non-severe COPD patients (55.8% vs 35.2%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.024).</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the COPD group, 50 of 56 hypogonadal patients (89.3%) exhibited normal or low LH values (≤12<span class="elsevierStyleHsp" style=""></span>U/L), suggesting hypogonadotropic hypogonadism. The remaining 6 patients (10.7%) had appropriate elevations of LH levels (>12<span class="elsevierStyleHsp" style=""></span>U/L), suggesting testicular dysfunction with hypergonadotropic hypogonadism. Regarding FSH, 36 patients (64.3%) had normal or low levels (FSH ≤20<span class="elsevierStyleHsp" style=""></span>U/L) and 20 (35.7%) had high levels (FSH >20<span class="elsevierStyleHsp" style=""></span>U/L), with predominance of secondary hypogonadism. A total of 85.7% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6/7) of the patients from the non-COPD hypogonadal group had hypogonadotropic hypogonadism while 14.3%, hypergonadotropic hypogonadism.</p><p id="par0095" class="elsevierStylePara elsevierViewall">An association was seen between COPD and hypogonadism. The odds of hypogonadism were significantly higher in COPD vs non-COPD patients, regardless of age, BMI, and the presence of type 2 diabetes mellitus (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">In the COPD group, BMI was inversely related to total testosterone levels (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">s</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.36; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><0.001). No significant differences were found between median total testosterone levels stratified by current inhaled corticosteroid use, current smoking, and type 2 diabetes mellitus (<a class="elsevierStyleCrossRef" href="#sec0080">see supplementary material 2–4</a>).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study showed four main findings. Firstly, the prevalence of hypogonadism in COPD men was high and greater than in non-COPD men. Secondly, testosterone levels were lower in COPD vs non-COPD men. Thirdly, the prevalence of hypogonadism was higher in severe COPD. Lastly, in both groups, most hypogonadal patients had hypogonadotropic hypogonadism.</p><p id="par0110" class="elsevierStylePara elsevierViewall">According to international guidelines, diagnosis of hypogonadism is defined by the presence of symptoms along with low testosterone levels.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> Considering the presence of symptoms and low total testosterone levels (<300<span class="elsevierStyleHsp" style=""></span>ng/dL), we found a prevalence of hypogonadism of 41.8% in COPD men vs 10.0% in non-COPD men.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The previously reported prevalence of hypogonadism in COPD was 22% up to 69%.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a> The wide range of prevalence reported for hypogonadism may be attributed to differences in sample characteristics such as age, inclusion/exclusion criteria, associated comorbidities, use of chronic systemic corticosteroids or opioids, and sample size, as well as the diagnostic criteria used for defining hypogonadism (free or total testosterone, units, cut-off point, and measurement method used). These differences impair the comparison between studies. Only one study considered the presence of symptoms; the others defined hypogonadism based on low levels of total or free testosterone. Considering the presence of symptoms, a study<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a> reported a prevalence of hypogonadism associated with COPD of 25.5%. The higher prevalence stated by our study may be partly explained by the larger number of patients with severe disease (56% vs 33%).</p><p id="par0120" class="elsevierStylePara elsevierViewall">In COPD patients, the range of total and free testosterone deficiency has been reported to be around 22% up to 58%<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9,17,20-22</span></a> and 22% up to 69%,<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6,7,17,23,24</span></a> respectively. In this study, the prevalence of total and free testosterone deficiency in COPD was 47% and 70%, respectively, which is consistent with previously reported ranges. As the testosterone threshold that triggers symptoms of hypogonadism varies significantly between individuals,<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> the use of this measurement in isolation has limitations and may overestimate the prevalence of hypogonadism.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The prevalence of hypogonadism was higher in severe COPD vs non-severe COPD patients. These findings are consistent with the results of former studies.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">17,26</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The prevalence of hypogonadism in non-COPD men (10%) in this study was similar to that reported by the Massachusetts male aging study. This study used a similar definition and found a prevalence of hypogonadism of 9.4% in adult men aged 60–70 years.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> This similarity suggests that the sample of non-COPD patients in our study may be representative of the general population.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The prevalence of hypogonadism was 4-fold higher in COPD vs non-COPD men. Similar results have been found in all studies that use control groups. In agreement with our findings, several publications<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">9,17,20,23</span></a> have reported a higher prevalence of hypogonadism in COPD patients vs their respective control groups, with differences ranging from 10% up to 30%. Also, having COPD was associated with a 7-fold increase in the likelihood of developing hypogonadism vs patients without COPD, regardless of age, BMI, and type 2 diabetes mellitus. In line with this finding, a study reported that in COPD men, the OR of having hypogonadism was 1.4-fold higher vs non-COPD men<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> and another study found that COPD increases the OR for hypogonadism 24-fold, regardless of age and comorbidities.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">This study found that 89% of hypogonadal COPD patients had hypogonadotropic hypogonadism, which is consistent with the findings of other studies,<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7,23</span></a> which reported hypogonadotropic hypogonadism in 76% and 73% of cases of hypogonadal COPD patients. These findings might be attributed to an impairment of the hypothalamic–pituitary–gonadal axis due to hypoxemia or chronic inflammation or dysfunction of Leydig cells in the testes or a combination of all these factors.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Based on former studies, BMI presented an inverse relationship with testosterone levels.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8,22</span></a></p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limitations</span><p id="par0150" class="elsevierStylePara elsevierViewall">Our study has some limitations that need to be acknowledged. Firstly, the use of a single measurement for testosterone levels may lead to imprecise data due to significant intraindividual variation.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> However, we should mention that all former studies have also used a similar approach. Secondly, the study was conducted at a single tertiary health center, which may restrict the generalizability of our findings and result in a selection bias for severe COPD cases and these results may not be representative of the prevalence of hypogonadism among COPD patients in Argentina. Thirdly, there is potential information (classification) bias in non-COPD patients since no spirometry was ever performed to rule out COPD. However, this bias is unlikely in our sample because all non-COPD patients were non-smokers and the prevalence of COPD reported in non-smokers in Argentina is low (18%).<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> Fourthly, the study reliance on non-smoking status as the sole criterion for defining non-COPD men might introduce bias, as smoking could also impact the sexual function. Although the relationship between smoking and testosterone levels has been inconsistent in the literature, most observational studies suggest that smoking in men increases total testosterone.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> In addition, only 26% of COPD patients were former smokers.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Strengths</span><p id="par0155" class="elsevierStylePara elsevierViewall">Despite our limitations, this study has several strengths. Firstly, the study included a well-defined control group of non-COPD men. Secondly, the diagnosis of hypogonadism considered the presence of symptoms based on a validated questionnaire and adhered to a globally accepted threshold of total testosterone deficiency, as recommended by international guidelines.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> Lastly, this is the second largest sample size study to estimate the prevalence of hypogonadism in COPD.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Implications and future research</span><p id="par0160" class="elsevierStylePara elsevierViewall">Hypogonadism has an impact on the patient's quality of life; it is associated with decreased libido, sexual dysfunction, osteoporosis and fracture risk, anemia, and infertility.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a> Given the high prevalence of hypogonadism in COPD patients, these patients should be screened for symptoms of hypogonadism that may prompt a biochemical diagnosis to determine which patients would benefit from testosterone replacement therapy. Randomized, controlled clinical trials are needed to evaluate the efficacy of testosterone replacement therapy on quality of life and exercise tolerance in COPD patients.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusion</span><p id="par0165" class="elsevierStylePara elsevierViewall">In conclusion, this study found four major results: (1) the prevalence of hypogonadism in COPD was high and higher vs non-COPD men, (2) testosterone levels were lower in COPD vs non-COPD men, (3) the prevalence of hypogonadism was higher in severe COPD vs non-severe COPD men, and (4) in most cases, hypogonadotropic hypogonadism was found. The study also found that the prevalence of hypogonadism was 4-fold higher in COPD vs non-COPD men. Based on the findings of this study, COPD patients should be assessed for hypogonadism.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">Research grant support from the <span class="elsevierStyleGrantSponsor" id="gs1">Argentine Association of Respiratory Medicine</span>.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres2261788" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1888242" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec1888243" "titulo" => "Abbreviations" ] 3 => array:3 [ "identificador" => "xres2261787" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1888244" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Hormone studies" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Definition of hypogonadism" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Severity of COPD" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Sample size" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 8 => array:3 [ "identificador" => "sec0045" "titulo" => "Discussion" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Limitations" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Strengths" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Implications and future research" ] ] ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflicts of interest" ] 12 => array:2 [ "identificador" => "xack779248" "titulo" => "Acknowledgments" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-03-13" "fechaAceptado" => "2024-05-06" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1888242" "palabras" => array:5 [ 0 => "Chronic obstructive pulmonary disease" 1 => "Comorbidities" 2 => "Hypogonadism" 3 => "Hormones" 4 => "Testosterone" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec1888243" "palabras" => array:8 [ 0 => "ADAM" 1 => "BMI" 2 => "COPD" 3 => "FSH" 4 => "GOLD" 5 => "LH" 6 => "SD" 7 => "SHBG" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1888244" "palabras" => array:5 [ 0 => "Enfermedad pulmonar obstructiva cronica" 1 => "Comorbilidades" 2 => "Hipogonadismo" 3 => "Hormonas" 4 => "Testosterona" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypogonadism is a common finding of chronic obstructive pulmonary disease (COPD). However, the prevalence of hypogonadism in COPD varies among studies. The aim of this study was to determine and compare the prevalence of hypogonadism in men with and without COPD.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We conducted a cross-sectional study with 134 patients with stable COPD and 70 age-matched men with non-COPD. Hypogonadism was defined by the presence of symptoms according to the Androgen Deficiency in Aging Males questionnaire, along with total testosterone deficiency (<300<span class="elsevierStyleHsp" style=""></span>ng/dL).</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients had a mean age of 68 years (SD, 6), a body mass index of 28<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (SD, 6), and 17% were current smokers. The prevalence of hypogonadism was 41.8% in COPD men (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>56, 95%CI, 33–51) and 10.0% in non-COPD men (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7, 95%CI, 4–20), with a prevalence ratio of 4.2 (95%CI, 2.0–8.7, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The prevalence of low total testosterone concentrations (<300<span class="elsevierStyleHsp" style=""></span>ng/dL) were significantly higher in COPD patients vs the control group (47.0% vs 15.7%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><0.001). In the COPD group, 89.3% of patients had hypogonadotropic hypogonadism and 10.7%, hypergonadotropic hypogonadism. The prevalence of hypogonadism was higher in severe vs non-severe COPD patients (55.8% vs 35.2%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.024).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The prevalence of hypogonadism was high and greater in COPD vs non-COPD men. This study suggests that COPD patients should be screened for hypogonadism.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El hipogonadismo es frecuente en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Sin embargo, la prevalencia de hipogonadismo varía entre estudios. El objetivo del estudio fue determinar y comparar la prevalencia de hipogonadismo en hombres con y sin EPOC.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio de corte transversal que incluyó a 134 pacientes con EPOC estable y 70 hombres sin EPOC pareados por edad. Se definió el hipogonadismo por la presencia de síntomas según el cuestionario de Androgen Deficiency in Aging Males y una deficiencia de testosterona total (<300<span class="elsevierStyleHsp" style=""></span>ng/dL).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los pacientes tenían una edad media de 68 años (DE 6), un índice de masa corporal de 28<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (DE 6) y el 17% eran fumadores. La prevalencia de hipogonadismo fue del 41,8% en hombres con EPOC (N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>56, IC 95% 33-51) y del 10,0% en hombres sin EPOC (N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7, IC 95% 4-20), con una razón de prevalencia de 4,2 (IC 95% 2,0-8,7, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001). La prevalencia de concentraciones bajas de testosterona total (<<span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>ng/dL) fue significativamente mayor en los pacientes con EPOC que en el grupo de control (47,0% frente a 15,7%, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><0,001). En el grupo de pacientes con EPOC, el 89,3% presento un hipogonadismo hipogonadotropo y el 10.7% un hipogonadismo hipergonadotropo. La prevalencia de hipogonadismo fue mayor en pacientes con EPOC grave que en los no graves (55,8% versus 35,2%, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,024).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de hipogonadismo fue alta y mayor en hombres con EPOC que en hombres sin EPOC. Este estudio sugiere que los pacientes con EPOC deben ser evaluados para detectar hipogonadismo.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0190" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0085" ] ] ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1113 "Ancho" => 2053 "Tamanyo" => 201385 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow chart of patients enrolled with and without COPD.</p>" ] ] 1 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 759 "Ancho" => 990 "Tamanyo" => 46024 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Prevalence of hypogonadism in men with and without COPD. The prevalence of hypogonadism was greater in COPD vs non-COPD men. Error bars represent the 95% confidence interval. COPD, chronic obstructive pulmonary disease; *chi-square test.</p>" ] ] 2 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1221 "Ancho" => 1591 "Tamanyo" => 86127 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Total testosterone levels in men with COPD and without COPD. The median total testosterone levels were lower in COPD patients. The middle line marks the median; boxes indicate the interquartile range; whiskers represent the upper and lower quartiles and dots represent outliers. Horizontal dashed lines represent the lower limit of normal (LLN). COPD, chronic obstructive pulmonary disease; *Wilcoxon–Mann–Whitney test.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">COPD, chronic obstructive pulmonary disease; SD, standard deviation; BMI, body mass index; IQR, interquartile range; SHBG, sex hormone-binding globulin.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">COPD(<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>134) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-COPD(<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>70) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age in years, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.2 (7.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.3 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.887 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">BMI in kg/m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.8 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.5 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.227 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Smoking, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Former \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 (73.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Current \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (26.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Obesity, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (24.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.542 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Type 2 diabetes mellitus, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (12.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.103 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">SHBG nmol/L, median (IQR)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.9 (30.5–57.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.6 (36.2–58.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.269 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Free testosterone, median pg/mL (IQR)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 (40.4–63.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.1 (60.9–84.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Total testosterone ng/dL, median (IQR)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">310 (230–380) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">430 (350–500) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Total testosterone <300</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ng/dL, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (15.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3678708.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics and testosterone levels in men with and without stable chronic obstructive pulmonary disease.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">OR, odds ratio; 95%CI, 95% confidence interval; COPD, chronic obstructive pulmonary disease.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multivariate analysisOR adjusted (95%CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 (0.95–1.03) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.783 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Body mass index, kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.04 (0.97–1.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.235 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type 2 diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.52 (0.62–3.74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.359 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.06 (2.97–16.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3678709.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis for the association between COPD and hypogonadism in men.</p>" ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 231984 ] ] 6 => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "mmc2.jpeg" "Alto" => 619 "Ancho" => 852 "Tamanyo" => 41405 ] ] ] 7 => array:5 [ "identificador" => "fig0010" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "mmc3.jpeg" "Alto" => 619 "Ancho" => 852 "Tamanyo" => 37069 ] ] ] 8 => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "mmc4.jpeg" "Alto" => 619 "Ancho" => 852 "Tamanyo" => 37623 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0165" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "2022 GOLD Reports" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Global Initiative for Chronic Obstructive Lung Disease – GOLD [Internet]" "fecha" => "2021" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0170" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global and regional estimates of COPD prevalence: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. 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Journal Information
Original article
Prevalence of hypogonadism in men with and without chronic obstructive pulmonary disease: A cross-sectional study
Prevalencia de hipogonadismo en hombres con y sin enfermedad pulmonar obstructiva cronica: estudio de corte transversal
Horacio Matías Castroa,
, Pablo Knoblovitsb, Joaquin Maritano Furcadaa, Eduardo Luis De Vitoc, Sebastían Matias Suarezb, Pablo Rene Costanzob
Corresponding author
a Pulmonology Department, Hospital Italiano de Buenos Aires, Argentina
b Andrology Section, Endocrinology, Metabolism and Nuclear Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
c Institute of Medical Research Alfredo Lanari, Faculty of Medicine, University of Buenos Aires, Argentina