Endocrine Abstracts

Introduction: Hypogonadism is common and occurs prematurely in human immunodeficiency virus (HIV)-infected men, being hypogonadotropic hypogonadism (HH) more frequent. However, HH with very low testosterone has not been described. We present three HIV-infected men with severe HH and normal pubertal development.

Case report: Three HIV-infected men, with HIV-1 diagnosis at the ages of 22, 34 and 35 years. Two of them had depressive syndrome, one treated with escitalopram and the other with mirtazapine. The one diagnosed with HIV when he was 22 started antiretroviral drugs (protease inhibitor and reverse-transcriptase inhibitors) at the age of 25 and seven years later complained of decreased libido, unejaculation and erectile dysfunction. The second one presented with decreased libido, unejaculation and hair loss in androgen-dependent areas 6 months after the HIV diagnosis. The third started antiretroviral drugs (reverse-transcriptase inhibitors) at the time of HIV diagnosis and 1 year later referred anejaculation and decreased libido. Laboratory tests revealed HH in all of them (FSH 1.48 and 0.7 U/l; LH 0.46, <0.12 and <0.07 U/l; total testosterone 24.2, <10 and 37 ng/dl and free testosterone 0.66 and 0.46 pg/ml). Prolactin, estradiol, the other pituitary axis and the sellar and head computed tomography scan were normal. All had normal CD4 count at the time of HH diagnosis. They started testosterone replacement therapy, with testosterone normalization and symptoms improvement.

Conclusions: Causes of HH in HIV-infected men include undernutrition, severe illness, drugs (psychotropics, opiates, megestrol acetate or steroids), pituitary dysfunction and co-morbid conditions, as antibody to hepatitis C virus seropositivity and injection drug use. Despite having none of these features (except two patients that were treated with low-dose psychotropics), our patients had HH with uncommonly low testosterone. This suggests that a different mechanism could contribute to severe HH in HIV-infected men. Screening for hypogonadism in all HIV-infected men might help to understand its etiology.