Endocrine Abstracts

Recognition of male adult onset hypogonadotrophic hypogonadism (HH) is important in identifying treatable forms of infertility, erectile dysfunction and osteoporosis.

There are currently no evidence-based guidelines for diagnosing and treating HH.

We evaluated the assessment, diagnosis, treatment strategies and outcome in adult men with suspected HH seen in our endocrine clinic over 1 year. We aimed to evaluate the usefulness of pituitary MRI, dynamic endocrine tests, and whether cardiovascular risk and bone health assessment was carried out.

Results:

19 patients were audited (mean age of 54 years (range 35 to 65)). Most patients presented with erectile dysfunction. One presented with osteoporosis and one with infertility. All patients had testosterone and LH measurements but SHBG was checked in only 9. Total serum testosterone was < 9 nanomol per litre (range 1.84 - 8.8 nanomol per litre) in 15 patients (79%). LHRH tests were carried out in 4 patients. Pituitary MRI was carried out on 95% of patients. 3 pituitary adenomas were found (2 prolactinomas and 1 non functioning ). No patients with isolated HH had abnormal pituitary imaging.

16 patients had DEXA scanning (85%) - 6 had osteopenia and 3 had osteoporosis. Most patients had some cardiac risk assessment although all parameters including fasting lipids, glucose, blood pressure, and ECG were not universally checked. 6 (30%) patients had BMI measurement. 4 had a BMI of >30, and 3 were diagnosed with obesity related hypogonadism. Patients treated with androgens had symptomatic and biochemical improvement.

Conclusions:

We recommend evidence-based guidelines for assessment, and routine baseline testing of pituitary hormones in all patients with suspected HH. Where fertility is not an issue, MRI and LHRH tests should be done selectively on patients in whom other baseline pituitary tests are also abnormal. Bone health and cardiac risk assessment and prevention is imperative in all (especially obese) patients. Timings of blood samples for testosterone should be standardised and correcting reference ranges for age should be considered.