Université Paris Sud 11, Assistance Publique Hôpitaux de Paris, Service d’Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, 94275 Le Kremlin Bicêtre
Acquired hypogonadotropic hypogonadism (AHH) is being increasingly recognized in adult men. Although a pituitary tumor, particularly prolactinoma, is the most common cause, a tumor or cyst in the hypothalamus or infundibulum ; infiltrative, vascular, and other disorders ; pituitary surgery and trauma or cranial/pituitary radiation therapy may also cause AHH.The clinical manifestations of AHH depend on the degree of gonadotropin deficiency and the rapidity of its onset. Men with AHH have decreased libido and erectile dysfunction ranging from decreased tumescence to complete impotence ; The patient’s sexual partner may be the one to report sexual dysfunction. The physical examination is usually normal if hypogonadism is of recent onset. Diminished facial and body hair, fine facial wrinkles, gynecomastia, and soft testes are characteristic of long-standing (years) hypogonadism. The volume of ejaculate may be decreased. Men with AHH may have normal or low serum luteinizing hormone and FSH concentrations, but normal values are inappropriate if the serum testosterone concentration is decreased. In the majority of AHH patients, serum inhibin B is normal. The decrease of this sertolian hormone indicates a long-standing and severe gonadotropin deficiency.Testosterone deficiency in men is thought to cause a decrease in libido, muscle mass, strength, and a sense of well-being, all of which may improve with testosteroen replacement therapy.