Hypergonadotropic hypogonadism and chromosomal aberrations: clinical heterogeneity and implications on the health of elderly men, case series.

BACKGROUND: Hypogonadism in older men is often considered as late onset hypogonadism. However, this clinical condition results from primary testicular failure which could be of genetic origin with Klinefelter syndrome being the most common chromosomal abnormality associated with it. CASE PRESENTATION: We report a heterogeneous group of cases who were diagnosed with hypergonadotropic hypogonadism in their adulthood and were found to have rare chromosomal aberrations. All were elderly men (in their 70 s and 80 s) for whom the diagnosis was made during the evaluation of incidental symptoms suggestive of endocrinopathy. The first had hyponatremia; the other two had gynaecomastia and features of hypogonadism noted during admission for various acute medical problems. With respect to their genetic results; the first had a male karyotype with balanced reciprocal translocation between the long arm of chromosome 4 and the short arm of chromosome 7. The second case had a male karotype with one normal X chromosome and an isochrome for the short arm of the Y chromosome. The third case was an XX male with unbalanced translocation between the X & Y chromosomes with retention of the SRY locus. CONCLUSION: Hypergonadotrophic hypogonadism in the elderly, may be due to chromosomal aberrations, resulting in heterogeneous and diverse clinical phenotypes. Vigilance must be exercised when seeing cases with subtle clinical findings. This report suggests that in selected cases of adult hypergonadotropic hypogonadism, chromosomal analysis may be indicated.

Bilateral Femoral Neck Fractures in a Middle-Aged Female After a Low-Energy Fall.

BACKGROUND: Bilateral hip fractures after low-energy mechanism are a rare phenomenon. Most published case reports include presentations of bilateral hip fractures in the elderly with low-energy mechanism. There is no report, to our knowledge, that illustrates this rare occurrence in middle-aged individuals after a low-energy fall from standing height. CASE PRESENTATION: We present a case of a 50-year-old female with history of cerebrovascular accident (CVA) who presented to our institution with bilateral valgus-impacted femoral neck fractures after a mechanical fall from standing height. The patient underwent successful in-situ percutaneous screw placement in bilateral hips. CONCLUSION: Although patient age is an obvious risk factor, middle-aged individuals with a medical history affecting bone mineral content may also be prone to bilateral insufficiency fractures. Individuals complaining of joint pain (with a history of conditions including renal failure, obesity, endocrinopathies, etc.) should have advanced imaging, if screening plain radiographs are negative, in an effort to identify occult fractures.