Clomiphene citrate treatment for late onset hypogonadism: rise and fall

ABSTRACT Objective: Previous series have demonstrated that Clomiphene Citrate (CC) is an effective treatment to increase Total Testosterone (TT) in Late Onset Hypogonadism (LOH) patients. However, what happens to TT levels after ending CC treatment is still debatable. The objective of this study is to evaluate TT levels 3 months after the discontinuation of CC in patients with LOH who were previously successfully treated with the same drug. Materials and Methods: Twenty-seven patients with LOH that were successfully treated (achieved TT levels >11nmol/l) with CC 50mgs daily for 50 days were prospectively recruited in our Andrological outpatient clinic. CC was then stopped for 3 months and TT levels were measured at the end of this period. Results: Mean TT level before discontinuation of CC was 22.7±8.1nmol/L (mean±SD). Three months after discontinuation, mean TT level significantly decreased in all patients, 10.2±3.9nmol/l (p<0.01). Twenty-one patients (78%) decreased TT levels under 11nmol/L. Six patients (22%) had TT levels that remained within the normal recommended range (≥11nmol/l). No statistical significant differences were observed between both groups. Conclusion: In the short term LOH does not seem to be a reversible condition in most patients after CC treatment. More studies with longer follow-up are needed to evaluate the kinetics of TT in LOH.

Desarrollo puberal espontáneo en una mujer con disgenesia gonadal pura 46, XY / Spontaneous puberal development in a woman with pure gonadal dysgenesis 46, XY

Presentamos el caso de una mujer de 26 años que tuvo su menarquia a los 16 seguida de dos ciclos menstruales espontáneos y luego amenorrea. Su examen físico mostró una estatura normal, proporciones corporales eunucoides, desarrollo mamario adulto, distribución pilosa normal, genitales externos femeninos normales sin virilización, útero hipoplásico y anexos no palpables, lo que fue confirmado por ecografía. Su cariotipo fue 46, XY. Tenía niveles plasmáticos elevados de FSH y normales de testosterona. Con el diagnóstico de disgenesia gonadal pura XY en su forma completa, se realizó gonadectomía bilateral. El estudio microscópico, demostró presencia de tejido fibroso tipo estroma ovárico con múltiples calcificaciones nodulares, sin estructuras foliculares, ni células de Leydig. Sertoli o carácter maligno. El cariotipo de ambas gónadas fue 46, XY. El estudio molecular de su ADN genoma mostró ser SRY positivo. Se discuten las bases del diagnóstico de disgenesia gonadal completa XY en este caso y los posibles mecanismos etiopatogénicos involucrados

Hipogonodismo en el varón por hiperprolactinemia tumoral / Hypogonodism in man by tumoral byperprolactinemia tumor

Se presenta un caso de no muy frecuente observación, cuyo interés está dado porque su exteriorización clínico-semiológico corresponde a un hipogonadismo en el que se demostró la presencia de lesión orgánica hipofisaria (prolactinoma)