Sertoli Cell Only Syndrome (SCOS) is a rare cause of male infertility in which the cause is often unknown.
Here, we report an unusual presentation of SCOS in a 32 year old man with severe fatigue, flushing, aches and hypothyroidism. These symptoms did not improve despite correcting hypothyroidism with thyroxine replacement. There have been no features of depression and he has been investigated thoroughly as predominant fatigue has been affecting everyday life. Patient is married and has no children. Bedside observations and general physical examination is normal. Laboratory testing for anaemia, kidney function, Vitamin D, liver function, coeliac screen, vascuilitic screen and anti-acetylcholine-receptor-antibody is negative. Plain X-ray of chest is normal. Pituitary axis testing revealed raised Follicle Stimulating Hormone (FSH) of 34.4 IU/L (normal < 8 IU/l), borderline Lieutinising Hormone (LH) of 8.5 IU/L (normal 3-8 IU/L), normal prolactin, normal levels of morning cortisol and normal Short Synacthen Test. His semen analysis confirmed Azoospermia. Patient is diagnosed with probable SCOS and is awaiting biopsy confirmation.
Treatment with a trial of Testosterone therapy is considered and we will have the outcome of this on patients symptoms in due course.
There has been poor reporting of symptoms in SCOS except commonest investigating cause of infertility. We hope, via sharing this case and further discussions amongst experienced clinicians will help broaden our understanding of symptoms of SCOS.