Division of Gastroenterology Department of Medicine, Philippine General Hospital-University of the Philippines Manila

Abstract

Introduction Hypogonadotropic hypogonadism (HH) is a form of gonadal failure secondary to deficient gonadotropin secretion. HH that occurs in association with impaired secretion of other pituitary hormones result from defects in pituitary cell differentiation. We present two adult males with secondary hypogonadism, hypothyroidism and adrenal insufficiency. Case A 32-year-old admitted for viral encephalitis was incidentally found to have absent secondary sex characteristics, microphallus and cryptorchidism. Diagnostics revealed low testosterone levels 0.025 nmol/L (NV=2.8–8), low DHEAS 3.9 ug/dL (NV=120-520) with inappropriately low LH 0.345 mIU/L (NV 1.7–8.6) and FSH 0.421 mIU/mL (NV=1.7–8.6).TSH was normal at 0.837 UIU/ml (NV=0.3–5) but with low FT4 6.96 pmoL/L (NV 11–22) and FT3 0.805 pmoL/L (NV 3.1–6.5). Morning serum cortisol was decreased at 74.26 nmoL/L (NV=171-536). The second patient is a 50-year old male with eunuchoid habitus complaining of low energy. Laboratory results similarly showed normal TSH 3.7 UIU/mL with decreased values of the following: FT4 8.42 pmol/L, morning cortisol 59.94 nmol/L, testosterone 0.020 nmol/L, LH <0.100 mIU/L and FSH 0.276 mIU/mL. Both had unremarkable pituitary imaging and normal male karyotypes. Hormone replacement therapy was given. Conclusion Detection of low testosterone and gonadotropin levels confirms the diagnosis of male hypogonadotropic hypogonadism. Early recognition and diagnosis of HH including associated hormone deficiencies can prevent negative physical and psychological sequelae and restore fertility in affected patients, thereby improving quality of life.