Endocrine Abstracts

Eating disorders are less common in men than in women. Furthermore, in males, a restrictive eating behaviour is frequently secondary to other psychiatric disorders. In case of suspected primary anorexia nervosa (AN), in male patients it is obviously impossible to rely on a typical clinical sign as is amenorrhea.

Case description: A 23-yr old man came to our observation because of an important weight loss in the last two years (from 60 to 48 kg, body mass index at the moment of observation 15.6 kg/m²). He denied voluntary restriction of food intake or physical hyperactivity, vomiting, as well as diuretic or laxative abuse. Endocrine evaluation showed normal thyroid function, slightly increased urinary free cortisol, low IGF-I, reduced levels of free testosterone and very low concentrations of gonadotropins. MRI did not disclose any abnormalities of the hypothalamic-pituitary region. According to these findings, the patient was evaluated by a psychiatrist and, upon detailed inquiry, he admitted severe reduction of food intake and physical hyperactivity along with diminished libido and impotence. A diagnosis of AN was established. The patient refused psychopharmacological treatment but, following psychotherapy, spontaneously increased food consumption, reduced physical activity and gained 13 kg in the following ten months. A parallel increase in circulating gonadotropins and free testosterone, along with the reinstatement of normal libido and erectile function, was registered.

Comment: This case report underlines the importance of assessing pituitary-gonadal function in men with alimentary restriction likely related to psychological disorders. Indeed, in a male patient in whom AN is suspected, the presence of hypogonadotropic hypogonadism may be useful in confirming this diagnosis, representing a marker equivalent of amenorrhea in women.