Endocrine Abstracts

Introduction: Male hypogonadism may complicate Addison’s disease (AD), but the prevalence of testosterone deficiency in adult males with primary hypoadrenalism is unknown.

Methods: Male patients older than 18 years of age enrolled in the South African AD national registry were screened for biochemical testosterone deficiency (early morning basal testosterone <9.9 nmol/l). Testing was also performed to see if these subjects were more susceptible to metabolic disease.

Results: Of the 42 males studied, 14 (33%) were hypogonadal (5 previously diagnosed, 9 newly diagnosed). The presence of testosterone deficiency was not related to age, the duration of disease, or the hydrocortisone dose required. Underlying causes of AD for the hypogonadal group were autoimmune in 7 (50%), tuberculosis in 3 (21%), X-linked adrenal hypoplasia in 2 (14%) and 2 (14%) were idiopathic. None of the 14 hypogonadal subjects had anti-gonadal autoantibodies. Untreated hypogonadal subjects had a higher BMI compared to eugonadal subjects (29.4 kg/m² interquartile range (IQR): 24.8–32.5 vs 24.3 kg/m² IQR: 22.6–26.7, P=0.029), and a higher high-sensitive CRP (5.0 mgl/l IQR: 2.5–14.0 vs 1.5 mgl/l IQR: 0.6–2.8, p=0.001). There was no difference found between the two groups in terms of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides or fasting glucose. Luteinizing hormone and follicle stimulating hormone did not differ between the groups, however dehydroepiandrosterone sulphate was significantly decreased in the hypogonadal group (0.31 μmol/l, IQR: 0.27–0.37 vs 0.75 μmol/l, IQR: 0.51–1.50, P=0.005).

Conclusions: Biochemical testosterone deficiency was highly prevalent in this AD group and not related to age or duration of AD. Untreated hypogonadal subjects had an increased BMI and hsCRP, but no difference was found in their lipid profiles, or glucose levels. It may be worthwhile to evaluate all male patients periodically with AD for testosterone deficiency, as testosterone replacement may improve long-term subjective and clinical parameters.