Endocrinologic evaluation of male hypogonadism: Kallmann's syndrome

Choi, Ho Cheol; Lee, In Kyu; Kim, Chun Il

Abstract

A clinical investigation and hormonal study was on 36 patients of male hypogonadism who visited the Department of Urology, Dong San hospital, Keimyung university, School of Medicine from March, 1986 to August, 1990, retrospectively. The results were as follows; 1. The cause of primary hypogonadism was Klinefelter's syndrome in all 27 cases. In patients with secondary hypogonadism, there were 7 cases of Kallmann's syndrome, a case of delayed puberty and a case of pituitary tumor. 2. The major physical feature was delay in sexual maturation. In addition, anosmia was found in 4. cases, gynecomastia in 3 cases, family history in 2 cases, cryptorchidism in 2 cases, color blindness in 1 case, obesity in 1 case and associated renal agenesis in 1 case. 3. In hormonal study of primary hypogonadism patients, serum LH was 30.8 mIU/ml, serum FSH 40.3 mIU/ml and serum testosterone 3.9 ng/ml. The results of hormonal study in secondary hypogonadism were serum LH 1.4 mIU/ml, serum FSH 1.9 mIU/ml, serum testosterone 0.3ng/ ml and serum prolactin 4.2 mIU/ml. 4. LHRH stimulation test was performed in secondary hypogonadism to differentiate hypothalamic and pituitary lesion. In 4 cases of Kallmann's syndrome and a case of delayed puberty, 597.6+/-191.4% increase in circulating LH and 365.0+/-218.8% increase in circulating FSH were seen. In 3 cases of Kallmann's syndrome, 200% increase in circulating LH and 153% in crease in circulating FSH were found. A case of pituitary tumor shows 163% increase in circulating LH and 325% in circulating FSH. 5. The treatments of patients with secondary hypogonadism were composed of HCG and HMG administration. Dosage of HCG was 3000 IU, two times a week and HMG administration was combined to restore fertility. 6. To differentiate the hypothalamic from pituitary lesion, a single LHRH test was not always possible, because the limited or absent response to LHRH might indicate either pituitary lesion or pituitary hyporeponsiveness due to chronic deprivation of endogenous LHRH. In this respect, a prolonged LHRH stimulation test and triple stimulation test may help to differentiate hypothalamic from pituitary lesions.