Originally published as JCO Early Release 10.1200/JCO.2005.02.176 on February 28 2005

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The Metabolic Syndrome and Disturbances in Hormone Levels in Long-Term Survivors of Disseminated Testicular Cancer

From the Departments of Medical Oncology, Vascular Medicine, Endocrinology, and Surgical Oncology, University Hospital Groningen, 9700 RB Groningen, the Netherlands

Address reprint requests to Jourik A. Gietema, MD, PhD, Department of Medical Oncology, University Hospital Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, the Netherlands; e-mail: j.a.gietema{at}int.azg.nl

PURPOSE: 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.

PATIENTS AND 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.

CONCLUSION: 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.

Supported by grant RUG2000-2177 from the Dutch Cancer Society.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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