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What is the management of hypogonadism in postoperative cases of acromegaly?

waelhammad
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2022-11-18
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A woman 31 years of age who is a follow-up case of acromegaly comes to the endocrinology outpatient department for follow-up. She was operated about 5 years back after which she was subjected to radiotherapy because of the residual lesion and persistently high postoperative growth hormone levels of 10 ng/mL and high levels of IGF-1. She is now four years post-radiotherapy and has come for follow-up. She has IGF-1 levels of and post-glucose growth hormone levels of 5 ng/mL. She has regular menstrual cycles and has got married. She wants to now plan for pregnancy and wants an opinion, if she can go ahead. She has a cycle with intermenstrual distance of 30 days and her 23rd day’s progesterone levels are 0.1 ng/mL. What should she be advised now?

What is the management of hypogonadism in postoperative cases of acromegaly?

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waelhammad
2022-11-18
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The hypogonadism is seen in 50% of the patients and is reversible. The biochemical diagnosis in males may be difficult, due to low sex hormone-binding globulin levels, thus making interpretation of total testosterone values more challenging. In these circumstances, assessment of clinical symptoms and bioavailable testosterone are important for diagnosis. Concomitant hyperprolactinemia should be considered as a cause of hypogonadism. Treatment of hypogonadism is done as it is done in a nonacromegaly patient. The females can be diagnosed easily.

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