Abstract
The observed increased incidence of idiopathic anal fistulae in men compared with women cannot be explained by the cryptoglandular hypothesis alone. Male predilect on is even more pronounced in neonates and is also seen in the canine population. Investigations into hormonal aspects of hidradenitis suppurativa suggest a possible influence of androgens in its pathogenesis. In order to investigate the possibility of a similar effect in fistulain-ano, we have compared a range of circulating sex hormones in 15 male and 12 female patients with anal fistulae with those in equal numbers of age-matched controls. There were no differences in levels of any measured hormones between male patients and healthy controls. There was no evidence of increased androgenisation of female patients. Women with fistulae had higher levels of circulating oestradiol (253 vs 163 pmol/l, medians, P=0.03) and lower levels of progesterone (1.05 vs 3.0 nmol/l, medians, P=0.039) than healthy women. Further work is merited to investigate the possiblity of increased local androgen conversion in anal glands.
Résumé
La différence observée dans l'incidence de fistule anale idiopathique chez l'homme comparée à celle de la femme ne peut être expliquée par la seule hypothèse d'une origine crypto-glandulaire. Un taux plus élevé est observé chez les nouveau-nés de sexe masculin et également dans la population canine. Des investigations hormonales chez des sujets porteurs d'une hidrosadénite suppurative suggèrent un rôle éventuel des androgènes dans cette pathogénèse. Afin d'investiguer la possibilité d'une action identique dans les fistules anales, nous avons comparé le taux d'hormones sexuelles circulantes chez 15 hommes et 12 femmes présentant des fistules anales avec un nombre identique de sujets témoins appareillés quant à l'âge et au sexe. Il n'y a pas de différence dans les taux sanguins d'aucune des hormones mesurées entre les patients et les contrôles sains. Il n'y a pas d'évidence d'une androgénisation accrue des patientes femmes. Les femmes avec des fistules ont un taux plus élevés d'oestradiol circulant (253 vs 163 pmol/l, médiane, P=0.03) et un taux abaissé de progestérone (1,5 vs 3.0 nmol/l, médiane, P=0.039) que les femmes témoins. Cette étude doit être poursuivie pour investiguer l'éventualité d'un catabolisme augmenté des androgènes dans les glandes anales.
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Lunniss, P.J., Jenkins, P.J., Besser, G.M. et al. Gender differences in incidence of idiopathic fistula-in-ano are not explained by circulating sex hormones. Int J Colorect Dis 10, 25–28 (1995). https://doi.org/10.1007/BF00337582
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DOI: https://doi.org/10.1007/BF00337582