Endocrine Abstracts

Introduction: Hypogonadism is linked to anaemia, sarcopenia and osteoporosis in men. Whereas secondary hypogonadism (SH) is biochemically indistinguishable from nongonadal illness, primary hypogonadism (PH) can be easily diagnosable by the identification of raised gonadotropins.

Case Presentation: A 66-years old male with a background history of type 2 diabetes mellitus, arthritis, and hypertension was referred to the haematology services to investigate his anaemia. Other past medical history included osteoporosis which he is under the follow up of the bone clinic. He had no history of gastrointestinal bleeding, malignancy or kidney diseases. His regular medications included bisoprolol, candesartan, Alendronic acid, metformin and atorvastatin. He was sexually active and reported no concerns with regards to his sexual performance. His main complaint was tiredness. He was noted by his general practitioner to have abnormal full blood for the last year with haemoglobin of 119–127 g/l (reference range 130–180) and haematocrit of 0.35–0.37 l/l (reference range 0.4–0.5). Other aspects of blood component were otherwise normal. His serum folate was 4.2 ug/l (reference range 3.9–26.8), B12 402 pmol/l (reference range 145–569) and serum ferritin 105 ug/l (reference range 20–300 ug/l). After a referral and investigation by the haematology team, he was labelled as having ‘unexplained anaemia’. Given his osteoporosis and anaemia, serum follicular stimulating hormone (FSH) was requested to screen for primary testicular failure. His FSH was raised at 31 U/l (reference range <12), with subsequent investigations showing raised serum luteinizing hormone (LH) at 15.8 U/l with low total Testosterone of 8.4 nmol/land low free calculated Testosterone at 161 pmol/l (reference range 215–760 nmol/l), confirming the unequivocal diagnosis of primary hypogonadism. He was started on testosterone replacement therapy with intramuscular testosterone undecanoate, at an initial frequency of 1 g every 12 weeks. 6 months later, there was remarkable improvement in his symptoms, so as his testosterone levels and full blood count.

Conclusion: PH is a common cause of anaemia among older men. Testosterone treatment has the potential to completely reverse anaemia, as well as improving bone density, muscle bulk and, if relevant, sexual function. Screening for PH should thus form part of anaemia work up by all Physicians, not just Endocrinologists.