Gonadal Function in Men with Cushing Syndrome

Abstract

 Cushing syndrome (CS) is scarcely observed in males. Because of this rarity, the real prevalence of gonadal dysfunction in men with hypercortisolism is unknown. Our aim was to analyze gonadal abnormalities in 37 males with CS (median age=28.9±11years) comparatively to age matched healthy men (n=10). For the homogeneity of the study men over 50, children, patients taking medications and those with pituitary deficits were systematically excluded. For the remaining group, we took into account medical history, clinical examination, and hormonal assessment, by radio immunoassay, for testosterone (T), prolactin (PRL), follicle stimulating hormone (FSH), and luteinizing stimulating hormone (LH). Results: 21% consulted for impotency and/or gynecomastia. When questioned, 65.7% complained about decreased libido and erectile dysfunction. Except for 3, body hair growth and repartition, and testicular volume were normal. Gynecomastia was observed in 18.9%.Testosterone was equal to 2.79±1.62ng/ml vs 6.69±3.87ng/ml (p<0.0005). Low testosterone (<3ng/ml) was observed in 67.5%. PRL =9.8 ± 4.2ng/ml vs 4.9 ± 2.6ng/ml (p<0.01). FSH = 3.87 ± 1.9mu/ml vs 3.75 ± 2.25mU/ml (p<0.30). LH = 2.7 ± 2.2mU/ml vs 3.66 ± 0.86 (p<0.30). We have not found any correlation between cortisol and T, PRL or LH, but there was a positive and significant one with FSH (r=0.57, p<0.005). Conclusion: CS causes a franc hypogonadism in 65%. According to FSH and LH results glucocorticoids excess acts probably at hypothalamic pituitary level, but an increase in testosterone degradation and/or inhibition of testis receptors cannot be ruled out. So men with hypogonadism and/or gynecomastia should be systematically checked for CS.