Endocrine Abstracts

Functional hypogonadism has been described in association with acute severe medical or surgical illness, subacute recovery and chronic disease. We present a case of transitory hypogonadism manifested during a peri-surgical period. A 42-year-old patient was sent to the endocrinology clinic due to hypertension and a solitary adrenal mass. He was treated with bisoprolol and telmisartan, that he maintains until today. The evaluation favoured non-functional adenoma but during the follow-up new complaints arose. He was diagnosed heart failure NYHA class-I related to aortic valve dysfunction and thoracic aortic aneurysm with surgical indication. He had recently visited the urologist due to complaints of erectile dysfunction and mentioned a normal scrotal US evaluation and the prescription of a phosphodiesterase inhibitor. These complaints started during the pre-surgical period. He mentioned timed puberty (13 years old) and one daughter but declared reduced libido, reduced spontaneous erections, reduced turgor and reduced need of shavings. He had BMI 21 kg/m², no gynecomastia, normal sense of smell and adult volume testicles. His previous total testosterone (TT) evaluations were within reference range (265 and 310 ng/dl). The new laboratory analyses showed low TT on two separate evaluations, 104 and 181 (RI 249–836) ng/dl with inappropriately normal LH 3.12 U/l and FSH 5.18 U/l. Prolactin, IGF1 and ACTH were normal. MRI could not be performed because of the new prosthetic valve. He was started on monthly testosterone enanthate achieving normal TT levels (267 ng/dl) and remission of clinical complaints. After a period of 5 months, approximately 2 months after the heart surgery the patient felt he had regained shaving frequency and sexual turgor, withdrawing both the phosphodiesterase inhibitor and the testosterone substitution. After 5 months of no therapy he revisited the clinic and laboratory tests were performed with the finding of normal TT 295 ng/dl, normal FSH and LH.