Resumo

COSTANZO, P.R. et al. Insulin resistance and erectile dysfunction: Effect of treatment with metformin. Rev. argent. endocrinol. metab. [online]. 2010, vol.47, n.1, pp.13-20. ISSN 1851-3034.

Erection depends largely on the release of nitric oxide (NO) by vascular endothelium. Insulin resistance (IR), present in most subjects who have obesity, metabolic syndrome (MS) or type 2 diabetes mellitus (DM2) is a metabolic abnormality that produces endothelial dysfunction determined by minor synthesis and release of NO. Treatment with metformin improves erectile function in mice with erectile dysfunction (ED) and IR. Aims: To evaluate in ED patients: 1) the presence of IR; 2) the degree of severity of ED according to the presence of IR; 3) the effect of treatment with metformin on erectile function in patients with ED and IR. Methods: Prospective, randomized, controlled, double-blind placebo study. We included 81 patients with ED and 20 men without ED (control group). Exclusion criteria: pharmacologic, anatomic or endocrine ED (hypogonadism or hyperprolactinemia), DM2, prior prostatic surgery or chronic illnesses. The erectile function was rated according the International Index of Erectile Function 5. IR was measerud by HOMA index. Thirty patients with ED, IR and poor response to sildenafil were randomized to receive metformin or placebo. Results: Patients with ED had higher HOMA index versus control group: 4.9 ± 2.8 versus 3.6 ± 2.6, p=0.03. The prevalence of IR was higher in ED group versus control group: 77.7% versus 45.0%, p=0.008. We found a negative correlation between HOMA and IIEF-5: r:-0.21, p=0.04. Patients with ED and IR (n=62) had lower IIEF-5 score when compared with those without IR (n=19): 13.6 ± 4.3 versus 16.0 ± 3.1, p=0.04. After treatment with metformin patients with ED showed a significant increase in IIEF-5 score and a significant decrease in HOMA index both at 2 and 4 months of treatment. Changes in the IIEF-5 score and HOMA index were not observed in patients with ED receiving placebo. Conclusion: Our findings suggest that endothelial dysfunction caused by IR could be one of the pathophysiologial mechanisms of ED. Treatment with metformin in patients with ED reduces IR and could improve response to treatment with sildenafil. Rev Argent Endocrinol Metab 47: 13-20, 2010 No competing finantial interests exist.

Palavras-chave : Erectile dysfunction; Insulin resistance; Metformin; Sildenafil.

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