Two unusual cases of abnormal male sex hormone profile

Jeya Navaratnam; Siva Sivappriyan

doi:10.1530/endoabs.48.CP25

Case history: Two cases:

(1) NM 55-year-old man with no erectile dysfunction, normal libido, but low energy levels for 6 months. PH Hemithyroidectomy for benign nodule, CML with Philadelphia chromosome positive, vitamin D deficiency. Peripheral vascular disease secondary to kinase inhibitors.

DH Sildenafil, aspirin, ibuprofen, MagnaPhate, Vitamin D3 1000 units, Levothyroxine 50 mcg, Imatinib 400 mg started 10/2015

SH Non-smoker. Drinks 20 units/week

(2) KB 64-year-old man with normal energy levels, normal libido, but had erectile dysfunction since thrombotic stroke 2005 resulting in left sided hemiparesis

DH Folic acid, aspirin, lansoprazole, simvastatin

SH No alcohol, smokes 15/day

Investigations: Table illustrates blood results that were confirmed with a further test.

Results and treatment: Patient 1 demonstrates an inappropriately normal LH/FSH for a low testosterone level, suggesting a possible pituitary/hypothalamic problem. MRI pituitary was normal but showed an incidental lacunar infarct cerebellum. Patient was initiated on testosterone replacement.

Patient 2 has an inappropriately high FSH/LH for a high testosterone level. This was consistent with different assays.


Patient no.	Testosterone	LH	FSH	9 AM cortisol	TSH	Prolactin	IGF-1	HbA1C
1	6.6(↓)	2.9	5.9	527	6.4	119	14.6	36
2	42.6(↑)	28.9(↑)	13(↑)	444	<0.02^a(↓)	322	19.7	–^b
aFree T4 was16.3 suggesting subclinical hyperthyroidism.
bPlasma glucose 5.8.

Conclusion and points of discussion: The first patient has biochemical results that illustrate hypogonadotrophic hypogonadism with normal pituitary gland. Therefore, the possibility of imatinib causing this abnormality has to be explored and discussed. There are many endocrine side effects of kinase inhibitors.

The results of the second patient are suggestive of un-inhibited elevated LH and FSH levels given the high levels of testosterone.

We would like to open these two cases for discussion.

Endocrine Abstracts

CP25