Background: Many adolescents and young adults with DMD receive long-term glucocorticoids (GC), a well-recognised cause of hypogonadotrophic hypogonadism. Pubertal induction is routinely offered to DMD adolescents in our centre but few individuals remain on supplementation into adulthood and it is unclear whether these men have age-appropriate endogenous testosterone production. Salivary testosterone (SalT) measurement is available but has not been used to assess androgen status in this setting.
Objectives: To assess SalT levels in men with DMD without the need for them to attend hospital and to compare androgen status with current/previous testosterone and GC usage.
Design, setting and participants: All adults with DMD were sent a Sal-T sampling kit and a short questionnaire covering GC/testosterone usage and Tanner self-assessment. Approval was not required by the local Research Ethics Committee as this was a service development initiative. SalT levels were measured by LCMS/MS in South Manchester University Hospital (adult male reference range: 70340 pmol/l).
Results: 36% of patients submitted a sample (26/75). Eighteen are currently available for analysis. Three were insufficient, 1 corresponded to a prepubertal boy, 1 was lost and 3 are pending. 9/18 were treated with GC (mean equivalent dose ~25 mg prednisolone). Eleven patients never received exogenous testosterone. One patient has started induction, six are post induction of whom three remain on testosterone. Median SalT was higher in those off-GC (255 vs 126 pmol/l). In the GC-treated group who had undergone induction, SalT was highest in those currently receiving testosterone (231 vs 126 pmol/l). Levels were lowest in those never exposed to testosterone (median: 77 pmol/l). 13/18 self-reported Tanner stages IVV. 2 patients never exposed to testosterone reported Tanner III.
Conclusions: GC therapy is associated with lower SalT concentrations in adults with DMD. There is evidence of some endogenous testosterone production following pubertal induction. As life expectancy of DMD adults improves, evaluation/treatment of androgen deficiency should be a priority given its potential role in well-being. SalT measurements can provide androgen status assesment of these patients at home.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes