Endocrine Abstracts

Introduction: The fact that up to 33% with type 2 diabetes develop hypogonadotropic hypogonadisms (HH), are still not catching enough attention. More futher ’’the 5-year mortality of somebody who has got diabetes, who has had a myocardial infarction is actually lower than the diabetic patient who has developed a diabetic foot ulcer, which is around 48%’’.

Case description: We describe male patient, 47 y. (on 2016y), newly diagnosed type 2 diabetes mellitus (already established background retinopathy; BG 18 mmol/l, pH 7.45) and amputation of digit V (infection cum necrosis). BP 170/90 mmHg, HR 110/min, on CW doppler noncompressible aa., in B mode calcified atherosclerotic plaques. BH 153 cm, BW 46.2 kg (BMI 19.6 kg/m2). CRP 116.8 mg/l, HbA1c 9.6%, TG 1.71, HDL chol. 0.81, cholest 4.91 mmol/l, US abdomen steatosis hepatis. 3 yrs ago he was anaemic. FSH 3.1 IU/l, LH 2.3 IU/l, testosteron (T) 5.82 nmol/l. In the next 3 months all small digits (II-V) were amputated, but still with nonhealed wounds. On twicely given premix insulin HbA1c 6.1%. In the time period 2016–2020y.: T 8.9 ± 3.1 nmol/l and estradiol (E) 33.75 ± 3.3 pg/ml while on clomiphene Tx T 21.9 ± 4.3 nmol/l and E 56 ± 8.5 pg/ml. On clomiphene, maximal FSH have been 8.1 and LH 5.6 mIU/ml. During 2017.y. wound on his foot heald. The only improved symptom of normal T level has been better erectile function (’’rigidity of penis’’). During low testosterone, a distinctive redness of cheekbones, and during both phases, testicles were with normal size and hardness. As a control patient we used Type 1 diabetic, with diabetic ketoacidosis, as a result of 4 day omission of insulin therapy, in december 2019. 7th day after admitance in Clinic T 6.9 nmol/l, FSH 4.1 and LH 8.15 miu/ but on 14th day T rised lspontaneously on 14.27 nmol/l (FSH 7.57 and LH 6.86), E 25 and 35 pg/ml.

Discussion: We conclude that our patient do have insulin resistance of neuronal cells that secrete GnRH but these cells are functional when we eliminate suppressive effect of estrogen by clomiphen. At the periphery it might have been positive effect of estrogen on wound healing in diabetic foot syndroma. Mild anemia that preceded diabetic foot wounds might be in relation to low testosteron. In second case, simple insulin therapy reestabished the function of neuronal cells that secrete GnRH.