Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2012) 28 P248

SFEBES2012 Poster Presentations Pituitary (43 abstracts)

‘Isolated acquired secondary hypogonadism’ in men referred to an adult endocrine clinic

Narayanan Kandasamy 1 , Mark Baxter 1 , Jordan Skittrall 1 , Anand Kumar Annamalai 1 , Nagui Antoun 2 , Helen Simpson 1 , David Halsall 3 & Mark Gurnell 1


1Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom; 2Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom; 3Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, United Kingdom.


Background: Acquired male secondary hypogonadism is a relatively common cause of referral to the endocrine clinic. However, the extent to which further investigation is required, and the indications for a trial of testosterone therapy, remain unclear. Aim To review the clinical/biochemical/radiological findings in men presenting with this condition.

Methods: We performed a retrospective case analysis of 41 consecutive patients referred to our clinic over a 30 month period with symptoms/signs of androgen insufficiency and a provisional diagnosis of acquired isolated secondary hypogonadism.

Results: The age of the cohort ranged from 17–71 years (13/41 <40 years). Duration of symptoms varied widely (6 months to 10 years). 12/41 and 10/41 patients had depression and diabetes mellitus respectively. 18 were obese and 11 were overweight. Testicular volumes <15 mL were noted in five cases, and gynaecomastia in four patients. Based on serum total testosterone levels (08:00–10:00 h), 7/41 patients had apparent severe hypogonadism (<5.2 nmol/l), 28/41 had mild-moderate hypogonadism (5.2–8.0 nmol/l) and 6/41 had ‘low-normal’ levels (8.0–11.5 nmol/l) (RR 8–29). However, calculated free testosterone (Vermeulen) was found to be low in only 7/34, consonant with the majority of the cohort having low SHBG levels (median 20.6 nmol/l, IQR 12.2–27.2, RR 10–57). Mild hyperprolactinaemia (prolactin <100 mU/L above RR), was observed in three patients, but no other endocrinopathy was detected in the cohort as a whole. Pituitary microadenomas (3–6 mm diameter) were found in three patients. 8/32 had evidence of osteoporosis, only one of whom had a low free testosterone level.

Conclusions: Most males referred with apparent acquired isolated central hypogonadism had normal calculated free testosterone levels, no associated endocrinopathy, and normal pituitary imaging, indicating a low yield with respect to further ‘pituitary investigation’ in this cohort. However, a surprisingly high rate of osteoporosis was observed.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.

Article tools

My recent searches

No recent searches.