| Popis: |
Background We present a patient with central and peripheral hypogonadism, decreased libido, and erectile dysfunction, who was previously diagnosed with Kallmann syndrome confirmed by serum hormone panel and ultrasonography. Clinical Case A 27-year-old male with a past medical history of hypogonadotropic hypogonadism, Kallmann syndrome, obesity, and dyslipidemia presented to the clinic with concerns about his reproductive health. There was no family history of hypogonadism. He was diagnosed with Kallmann syndrome at the age of 14 due to short stature and had been treated using testosterone therapy. He had paused therapy for 6 months prior to the visit for the trial of a new medication, Menopur, to improve his fertility. However, the therapy had failed to improve his sperm count. Laboratory tests showed a subclinical total testosterone level of 7 ng/dL which was consistent with hypogonadism, so testosterone therapy was restarted with weekly 200 mg/mL testosterone cypionate intramuscular injections. Results were also significant for dyslipidemia with total cholesterol 299 mg/dL, triglycerides 240 mg/dL, HDL 38 mg/dL, LDL-c 217 mg/dL, and elevated BMI of 38.52 kg/m2, for which the patient was started on rosuvastatin 20 mg daily and counseled on lifestyle modification. HbA1c levels were in the pre-diabetic range of 5.8%, and he was started on metformin 500 mg BID. On a repeat visit, the patient complained of painless testicular swelling, for which ultrasonographic imaging was ordered. The results showed bilateral small testes for age measuring 1.9×1.4×1.2 cm on right and 2.5×1.4×1.4 cm on left with a 0.6×0.4 cm left epididymal cyst and evidence of mild right hydrocele and left varicocele. The patient was referred to a genitourinary specialist for further investigation. On follow-up visit, the patient presented with new labs showing improvement with total testosterone 943 ng/dL, free testosterone 255.6 pg/mL, FSH Conclusion Failing of hormonal replacement in improving the fertility inpatient with central hypogonadism warranty the importance of gonadal examination. This is a patient with a past medical history of hypogonadotropic hypogonadism, who had been treated with testosterone since the time of diagnosis to improve his short stature and secondary sexual characteristics. Given the clinical picture of his testes and failed trial of a new drug regimen, there was a low chance of regaining fertility for this patient. Presentation: No date and time listed |
