Endocrine Abstracts

Nebido (testosterone undecanoate 1000 mg injection) was used to induce pubertal development in 2 apubertal men with Kallmann’s syndrome, in their 6th decade.

Case 1: Originally diagnosed with Kallmann’s syndrome aged 21, but then discontinued treatment for the next 25 years. Now aged 50, he was markedly eunuchoid: G3-4, P3, A1.

Investigations: Testosterone 1.0 nmol/l, LH and FSH <0.5IU/l.

Normal ferritin, PSA and pituitary function.

DEXA: severe osteoporosis at L-spine and right forearm, osteopaenia at hip.

Ultrasound: scrotal atrophic testes.

MRI: normal pituitary, absent olfactory bulbs.

Treatment & progress: He commenced Nebido in November 2006, initially every 2 months, but guided by serum Testosterone levels, the interval progressively increased to 4 months. He started feeling better from the first injection and is now fully virilised, has good erectile function and is shaving regularly.

Case 2: Noted to be apubertal at age 14, but was then lost to follow-up. Undergone bilateral orchidopexy at 41 years of age. Now aged 57, he was apubertal: G2,P2,A2.

Investigations: Testosterone <1.0 nmol/l, LH and FSH <0.5IU/l.

Normal ferritin, PSA and pituitary function.

Ultrasound: 3 ml scrotal testes.

DEXA: osteoporosis at hip and spine.

Treatment & progress: He commenced Nebido in October 2007, initially every 2 months, but guided by serum testosterone levels, the interval progressively increased to 4 months. He reported improved energy levels, increased facial/body hair, erections and voice deepening. He is now fully virilised.

Discussion: Short-acting testosterone preparations are recommended for treatment of pubertal delay. However, hypogonadal men presenting late in life have typically come to medical attention in their youth, but then dropped out of follow-up. Therefore, ensuring their adherence to re-institution of androgen replacement is paramount. Treatment should be convenient, not overly time-consuming and, to optimise psychological and emotional stability, should not cause wide fluctuations in serum testosterone. Nebido 1000 mg seems highly effective by all these parameters.