Endocrine Abstracts

Case History: Patient 1: A 44 years old gentleman with BMI of 44.7 was referred to the weight management clinic for the management of obesity. His weight was in obesity range since childhood and he reported excessive tiredness and lethargy. He also had history of anxiety and depression. Examination showed lack of body hair, reduced muscle mass and small testes. Patient 2: A 48 years old lady was referred to the endocrinology clinic for incidental adrenal adenoma. She reported gradual weight gain over years. She had central obesity with BMI at 53.4 and history revealed amenorrhoea since the age of 20 years.

Investigations: Patient 1: Pituitary tests performed in view of clinical findings, showed low Testosterone at 6.1 nmol/l, FSH 1.8 IU/l, LH 5 IU/l with normal TFTs, IGF-1, low cortisol but SST showed an adequate response. MR pituitary was normal. USS testes demonstrated reduced vascularity but normal testicles. Patient 2: Biochemical investigations for adrenal adenoma were negative Pituitary function test showed low gonadotrophins (FSH - 3.2, LH - <0.3 IU/l), elevated Prolactin at 171030 mu/l with normal IGF1, cortisol and TFT. MR pituitary showed large macroadenoma.

Results and Treatment: Patient 1: Results suggested hypogonadism secondary to obesity; His energy levels, exercise capacity and muscle mass improved with testosterone replacement. He achieved weight loss with liraglutide (Saxenda) with latest BMI at 35.3. Patient 2: Results suggested secondary hypogonadism caused by prolactinoma. She showed good response to treatment with dopamine agonist. Her weight did not reduce as she is likely to have developed hypothalamic obesity.

Conclusions and points of discussion: Obesity is a largest and fastest growing public health problem with a prevalence of ~27% in England. Concomitant hormonal diseases can be present in obesity, so it is important to work up with detailed history, examination and investigations to exclude hormonal pathology. It is a common practice to investigate for Cushing’s as a cause for obesity but other hormonal causes are usually overlooked. There is a bidirectional relationship between obesity and hypogonadism in men, so the presence of either condition could lead to the other. Our second patient did not have typical symptoms of prolactinoma like headache, visual defects or galactorrhoea despite the presence of large pituitary adenoma, so it is important to be aware that clinical features can be subtle. We present our patients to highlight the importance of addressing hypogonadism, as an aid to the management of unexplained obesity.