Data points to Nocturia-Hypogonadism link

Courtesy of renalandurologynews.com

Desmopressin treatment appears to reduce nocturia ( the need to get up in the night to urinate, thus interrupting sleep. Its occurrence is more frequent in pregnant women and in the elderly. Nocturia could result simply from too much liquid intake before going to bed (usually the case in the young), or it could be a symptom of a larger problem, such as sleep apnea, hyperparathyroidism,^[1] chronic renal failure, urinary incontinence, bladder infection, interstitial cystitis, diabetes, congestive heart failure, benign prostatic hyperplasia, ureteral pelvic junction obstruction,^[2] uterine fibroids, eating disorders, diabetes insipidus or prostate cancer ) and other lower urinary tract symptoms while also significantly increasing testosterone levels in men with late-onset hypogonadism. These new results from a 62-patient prospective trial suggest that nocturia may be related to hypogonadism in this population.

The study, by Jong Wook Kim, MD, PhD, of the Korea University Guro Hospital, Seoul, South Korea, and colleagues, analyzed the parameters of men treated with demopressin in an open-label trial that ran from April 2011 to November 2012. The men were older than 40 years, had at least two nocturia episodes per night, and serum total testosterone levels below 3.5 ng/mL or a positive score on the Androgen Deficiency in Aging Men scale. The investigators excluded individuals with cardiovascular disease, hyponatremia, primary hypogonadism, hypogoandotropic hypogonadism, or who were using hypnotics or desmopressin for treatment of other diseases such as diabetes. The subjects received desmopressin 0.1 mg once daily.

The study population had an average age of 68.4 years and average body mass index of 24 kg/m².  Their mean total testosterone at baseline was 4.28 ng/mL, their mean free testosterone was 5.47 pg/mL, and their mean PSA level was 1.4 ng/mL.

The total and free testosterone levels increased significantly in men with baseline total testosterone levels below 3.5 ng/mL, researchers reported at the 33^rd Congress of the Societé Internationale d'Urologie. Their mean total testosterone levels increased from 2.85 to 3.97 ng/mL and their mean free testosterone levels increased from 3.84 to 4.86 pg/mL.

In addition, the patients' average scores on the overall International Prostate Symptom Score (IPSS) scale dropped significantly, as did their scores on question 7 of the IPSS (which probes nocturia), the IPSS subscores of voiding and storage symptoms, and the IPSS quality of life question. The patients' nocturnal urine volume levels also fell significantly, as did their nocturnal polyuria index scores, their actual number of nightly voids, the nocturia index scores and their nocturnal bladder capacity index scores.

“Although the mechanism of action is still unknown, we suggest that desmopressin could correct disturbances of the circadian regulation of testosterone secretion,” the authors concluded in their poster presentation.

Parameters not changed by desmopressin treatment included blood urea and nitrogen level, creatinine level, potassium and chloride levels, overall International Index of Erectile Function score, and Aging Male Symptom score.