Hypogonadism associated with various stages of genetic haemochromatosis

Abstract

HYPOGONADISM ASSOCIATED WITH VARIOUS STAGES OF GENETIC HAEMOCHROMATOSIS M. Montini, A. Pedroncelli, U. Bonassi, G. Pagani, S.Fargion*,/LFracanzani* Divisione Endocrinologica OORR-Bcrgamo-ltsly, *Islituto di Medicina Interna II, Universit~ di Milano. Hypogonadotmphic hypogonadism is a recogeised complication of genetic haemoCtnomntosis resulting from selective deposition of iron in the gousdotrophinproducing cells of the pituitary.Aim of this study was to assess the hypothalamopituitary-gonadal axis both at baseline and by dynamic testing in patients with genetic haemochromatosis.Twenty male patients aged 45 years were studied.AU twenty patients underwent liver biopsy and eleven were found to have cirrhosis.in order to assess any tissue damage at either the pituitary or the gonadal level, the hypotlmlamo-pituitsry-genadul axis was evulnated by measuring serum LH and FSH in basal condition after the challenge with LHRH 100 meg administered intravenously.Blood samples for the assessment of LH and FSH were drawn 30, 60, 90, 120 and 180 minutes after the LHRH stimulas.Further, total and flee testosterone was assessed at baseline by sampling the patient every 20 minutes over a 40-minate pcdod and after 5-day treatment with chononic gonadotmphic injections 2000 IU administered intramuscularly.Blood was then sampled at 20minute interval over a 40-minute pofiod.To further investigate the adrenal function, DHEA-S was also determined. The patients were divided into 2 groups: group I consisting of patients witk no liver damage (10 patients; 50%) and group 2 consisting of patients with cirrhosis (10 patients; 50%).Groupl: basal serum LH anf FSH levels were witiltin the normal range in all but one patient. A normal respouse to the l.hlRI-I challenge was noted in aU patients. At baseline, serum total testosterone was within the normal range in 3/10 patients while serum free testosterone in 6/10 patients. Following the cliullange with ehorionic gonadotrophin, a two-fold increase in serum testosterone levels was recorded in 5/10 patients.Serum DI-IF_~-S was found to within the normal range in all but one patient.Group 2: at baseline, serum LH and FSH were within the normal range in 7/10 patients. Serum gonadotrophins response to LHRH was normal in 7/10 patients. Basal serum total testosterone was within the normal range in 1/10 patients while flee testosterone in 2/10 patients.A normal testosterone response to the 5--day chorionic gonadol~ophin challenge was observed in 2 of the ten patients.Serum DHEA-S resulted wi t l~ the normal range in 3 of the ten patients.The results of the study are in agreement with previous data about the presence of a damage of the hypothalamo-pituilarygonadal axis,Tliis positively correlates with the ~verity of the liver damage. Further, reduced activity of the cortical adrenal was also observed.This is worth being further investigated based on the present knowledge which excludes any adrenal damage in genetic lmemoehromatosis. IS A NON STEROIDAL ANALGESIC DRUG USEFUL TO PREVENT PAIN RISING A F r E R PERCUTANEOUS LIVER BIOPSY? L. Mo~Ui, N. Morlando, G. Schipani, G. Tarantino. Institute of Internal Medicine and Dismetabolic Diseases. School of Medicine Federico IF , Naples, ITALY.