PubMed · 255196
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M G Margolis, V K Mal'kovich. 1979. [Hormone therapy].. https://pubmed.ncbi.nlm.nih.gov/255196/
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Although endocrinopathies are not often seen in infertile men, these disorders are clinically significant; they often have potentially serious medical significance, regardless of fertility issues. Correction of these disorders represents a possible way to restore normal fertility for the male partner. Male fertility is critically dependent upon a normal hormonal milieu. The hypothalamic-pituitary-gonadal axis is quite sensitive to disruption by endocrine disorders and other generalized medical disorders. Thus, male infertility is occasionally the presenting sign for significant underlying medical disease; it is important to properly evaluate these patients.
Immune-mediated tissue destruction or disregulation is the cause of multiple common, as well as rare, endocrine disorders including type 1 diabetes, Graves' disease, Hashimoto thyroiditis, and Addison's disease. Each of these disorders can be divided into a series of stages beginning with genetic susceptibility, environmental triggering events, and active autoimmunity, followed by metabolic abnormalities with overt disease. Common genetic susceptibility is suggested by the clustering of a series of disorders in the same individual and his or her family. A major portion of the genetic susceptibility lies in the HLA region, but for several disorders, mutation of transcription factors underlies disease susceptibility (eg, X-linked polyendocrinopathy, immune deficiency and diarrhea, and autoimmune polyendocrine syndrome type 1). With improving immunogenetic and pathogenic understanding, type 1A diabetes is now predictable, and excellent autoantibody screening assays are available. This knowledge, combined with studies in animal models, has led to trials for the prevention of diabetes. In addition, aberrant immunologic reactions (eg, insulin autoantibodies after insulin therapy, Graves' disease after monoclonal anti-T-cell therapy in multiple sclerosis) can complicate standard and experimental therapies. We therefore believe that an understanding of the immunogenetics and immunopathogenesis of endocrine disorders can aid in the prevention of morbidity and mortality for these related diseases.
New medical information is accumulating at an astonishing rate. It is available in many forms and flavors, and information seekers benefit from being discriminating in searches for answers to clinical problems. Few problems can be addressed satisfactorily simply by entering some relevant content terms into Medline. Such a search, unless the problem is rare, usually results in a flood of citations with no arrangement according to quality, and the user must determine painstakingly which citations are relevant and clinically useful. Fortunately, evidence-based information services are catching up with the growth of the medical literature. Such services organize and provide access to the current best evidence at the point of need. We have described a "4 S" hierarchy of evidence-based resources to help focus a practitioner's information seeking strategies, with systems at the highest level of organization, followed by synopses, syntheses, and studies. Practitioners should become familiar with the best access routes for regularly updated services of relevance to their interests and direct their inquiries initially to the highest level of organization of information that exists for their interests. Evidence-based resources continue to be created and evolve, so keeping an eye out for new resources and examining their pedigrees according to the "4 S" approach permit practitioners to assemble and organize an ever-improving personal evidence-based library for endocrinology.