FRI438 A Unique Case Of Secondary Hypogonadism And The Covid Booster Vaccine

Abstract

Abstract Disclosure: O.Z. Syed: None. M. Shakir: None. K. Sajid: None. A. Sood: None. N. Bansal: None. 38-year-old male with no past medical or surgical history presented for an evaluation of his low testosterone. The patient transports patients in the hospital, he denies any medication use, including steroids, opioids, and antibiotics. He has a biological 8-year-old son and denied any history of viral infection recently and denied any history of testicular trauma, mumps, or radiation therapy. He started having fatigue, chronic mild headache, and generalized weakness after receiving his third dose of covid vaccine in January, however, he denied any diplopia, galactorrhea, hirsutism, or sexual dysfunction. He did not report any side effects with the previous 2 covid vaccines. After a couple of months of persistent symptoms accompanied by 40 pounds of weight loss( half of which he regained in a few months without intervention), he went to his PCP for evaluation. On physical examination, there were no abnormalities seen and as per the patient, there was no change in testicular size either. The patient was found to have mildly elevated prolactin of 17.8 with low free and total testosterone of 134 accompanied by FSH of less than 1.0 and LH of 1.4. The remaining labs include but are not limited to CBC, CMP, TSH, Vitamin D, CK, Sex hormone-binding globulin, and cortisol. The autoimmune panel, Hepatitis, HIV, and tick panels were negative. While he was being worked up he tested himself multiple times for covid and was negative. The patient had an MRI done which did not show any mass or lesions. Furthermore, he also had a Chest x-ray and CT of his abdomen/pelvis along with an Ultrasound of the abdomen, which did not show any concerning findings. The patient was started on testosterone gel at the endocrinology clinic with regular follow-ups to assess for response and side effects.As per the currently available literature, there have been multiple associations made between Covid 19 infection and hypogonadism. There have been reports of low testosterone following covid 19 infections and conversely there have been worse outcomes of covid 19 related to men with lower levels of testosterone. This could possibly be due to ACE 2 expression on testicular cells or due to secondary inflammation and oxidative stress inhbitiing steroidogenesis. However no literature was found linking the covid 19 vaccine to secondary hypogonadim other than a case of pituitary apoplexy. These findings in light of our case warrant further research into possible association between the covid vaccine and hypogonadism. In patients presenting with generalized weakness and similar vague symptoms, we need to consider a history of covid vaccination as it could potentially be a cause of secondary hypogonadism. Furthermore, more detailed and larger-scale studies need to be done concerning the covid booster vaccines and hypogonadism. Presentation: Friday, June 16, 2023