title: Primary infertility in 45-year-old man with untreated 21-hydroxylase deficiency: successful outcome with glucocorticoid therapy.
abstract: We describe a 45-yr-old man, who presented with primary infertility of 2 yr. He had small testicles with severe oligoasthenozoospermia and low serum gonadotropins, but normal serum T. The suppression of gonadotropin secretion by increased adrenal steroids due to untreated 21-hydroxylase deficiency appeared to underlie the failure in spermatogenesis. Hydrocortisone treatment was started and was modified later to include prednisolone to get optimal suppression of the secretion of ACTH and adrenal steroids. Within a few months, the gonadotropin levels became normal, and spermatogenesis was improved. A normal pregnancy was achieved.
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, PO Box 140, FIN-00029 Helsinki, Finland. aila.tiitinen@hus.fi
authors.forename: Aila
authors.initials: A
authors.lastname: Tiitinen
authors.forename: Matti
authors.initials: M
authors.lastname: Välimäki
mesh_terms: D015090:25-Hydroxyvitamin D3 1-alpha-Hydroxylase / Q000172:deficiency*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D007248:Infertility, Male / Q000209:etiology*; D008297:Male; D008661:Metabolism, Inborn Errors / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D011247:Pregnancy; D013091:Spermatogenesis / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone; D015090:25-Hydroxyvitamin D3 1-alpha-Hydroxylase; D006854:Hydrocortisone