Endocrine Abstracts

Introduction: We describe a case of a 29 year old man who was referred to endocrinology services with a 4 month history of erectile dysfunction, decreased libido and low testosterone. He denied symptoms suggestive of pituitary pathology. And he had no previous testicular infections or trauma. His past medical history included asthma, which was well controlled with b-agonist inhaler as required. He had normal development. He was a non smoker, abstinent from alcohol and a keen cyclist (cycling over 200 miles per week). He worked as a teacher. He was in a longterm relationship and he had never fathered children yet (by choice). They were planning for pregnancy with his partner in near future. On examination, weight was 77.4 kg, with a BMI of 22.9, normal secondary sexual characteristics and no other clinical features of hypogonadism. Visual fields were normal on confrontation.

Investigations and results: Pituitary profile: low morning testosterone confirmed on two separate samples (6 and 5), Inappropriately normal LH/FSH (1.7, 2.1 respectively), rest of pituitary profile was normal with a satisfactory morning cortisol level. Normal kidney and liver function. He also underwent MRI pituitary which was unremarkable and a bone densitometry scan; L1–L4 T score: −2, Hip T score: −1.2.

Conclusion and discussion: Based on the history and investigations above, a diagnosis of hypogonadotrophic hypogonadism (HH) was made. His symptoms coincided with a period of substantial physical activity (cycling over 200 miles per week) and he had lost approximately two stones in weight. Refraining from intense training and a period of monitoring was advised. A few months later, his testosterone level had increased and a sustained restoration of the gonadal axis with improvement of his symptoms were noted during his follow up appointments. However, a repeat DEXA scan after 1,5 years showed no improvement. L1–L4: T score: −2.2 (Z score −2.2) and hip T score −0.7 (Z score −0.6). He was offered treatment with bisphosphonates, after he sustained a medial condyle fracture. This case is an interesting demonstration of the transient phenomenon of low testosterone related to the acute stress of intense exercise training. Points for discussion: 1. Functional HH; 2. Treatment with testosterone and impact on fertility. 3. Impact on BMD.