We present two patients with unusual manifestations of sarcoidosis and review gonadal involvement in this rare but important disease. A 27 year old man presented to the Ophthalmologists at our hospital with a red eye. He was diagnosed with anterior uveitis and commenced on topical corticosteroids. Following discovery of a testicular mass, he underwent testicular ultrasonography which demonstrated bilateral hyperechoic lesions. Histological examination of an open surgical biopsy specimen revealed multiple, non-caseating granulomas with no spermatogenesis visible in the seminiferous tubules. Serum testosterone was low with elevated gonadotrophins and semen analysis confirmed azoospermia. He was commenced on high dose prednisolone without concomitant replacement of testosterone in an attempt to improve his azoospermia. FSH and LH concentrations fell in parallel with his disease activity and a repeat semen analysis demonstrated a significant rise in his sperm count (1.2 million/ml), allowing sperm banking to take place. A 31 year old man presented to his local hospital with a history of chronic rhinosinusitis, biopsy of the nasal mucosa confirming sarcoidosis. Endocrine testing demonstrated severe hypogonadotrophic hypogonadism and GH deficiency, and pituitary MRI showed thickening and infiltration of the infundibulum and hypothalamus. He was commenced on high dose corticosteroids, bisphosphonates, testosterone and GH replacement with good therapeutic response. These cases illustrate primary and secondary gonadal dysfunction in systemic sarcoidosis. Because of the unpredictable effect of sarcoidosis on the male genital tract, all patients with an interest in paternity should obtain a semen analysis at the time of diagnosis and offered sperm banking where indicated. Although corticosteroids form the mainstay of therapy for hypothalamic-pituitary sarcoid, there are few reports of their effectiveness in testicular disease. We suggest that steroid therapy should be considered for this indication, not only for control of systemic disease activity but also for recovery of gonadal function and spermatogenesis.
22 - 24 Mar 2004
British Endocrine Societies