A patient of hypogonadotropic hypogonadism accompanied by growth hormone deficiency and decreased bone mineral density who attained normal growth.
We present here a rare case of hypopituitarism accompanied by growth hormone (GH) deficiency and hypogonadotropic hypogonadism, in which the patient attained normal height but was of eunuchoid appearance. A 23-year-old man who had not reached puberty was referred to Saitama Medical School for hormonal evaluation. Basal hormonal data and hormone-stimulating tests revealed impaired secretion of GH, gonadotropins and adrenocorticotropic hormone (ACTH). Serum levels of testosterone, estrone, estradiol and estriol were all below the detectable ranges. The patient's plasma ACTH responded to corticotropin releasing hormone, but not to insulin-induced hypoglycemia. Serum GH showed a minimal response to GH-releasing hormone, but was unresponsive to insulin-induced hypoglycemia. Serum luteinizing hormone and follicle stimulating hormone did not respond to luteinizing hormone-releasing hormone. The results were compatible with a diagnosis of hypothalamic hypopituitarism. Magnetic resonance images of the brain showed a small anterior pituitary, an ectopic posterior lobe and transection of the pituitary stalk. Although the patient showed signs of hypopituitarism, he finally attained normal height, possibly because of failed epiphyseal maturation. His bone mineral density was markedly reduced to 0.647 g/cm2 in the lumbar spine; this level was 61.7% of the average level of healthy young males. Our findings were compatible with a recently advocated view that estrogen is important in promoting epiphyseal fusion and in determining bone density in males as well as females.
Fourth Department of Internal Medicine Saitama Medical School. wadas@saitama-med.ac.jp
S
S
Wada
A
A
Minagawa
K
K
Imamaki
S
S
Suda
K
K
Yamanaka
M
M
Iitaka
S
S
Katayama
D000324:Adrenocorticotropic Hormone / Q000172:deficiency; D000328:Adult; D001827:Body Height; D015519:Bone Density; D006065:Gonadotropins, Pituitary / Q000172:deficiency*; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D007006:Hypogonadism / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D007018:Hypopituitarism / Q000150:complications / Q000378:metabolism / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male
D006065:Gonadotropins, Pituitary; D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone