Male Hypogonadotropic Hypogonadism

  Table of Contents

  2.3 Acquired        2.4.2 Delayed Puberty

2.4 Partial Forms of GnRH Deficiency

2.4.1 Fertile Eunuch Syndrome

A second subset of patients with GnRH deficiency and evidence of testicular development are the so-called "fertile eunuchs". The fertile eunuch syndrome represents a partial form of GnRH deficiency where endogenous GnRH secretion is present, but diminished. The amount of GnRH secreted in this syndrome is sufficient to stimulate local intratesticular testosterone concentrations and allow testicular growth, but is insufficient to produce the systemic levels of testosterone necessary for full virilization. The clinical presentation of the fertile eunuch is rather similar to that of mid-pubertal boys. In addition, frequent sampling of LH secretion in two men with the fertile eunuch syndrome demonstrated augmentation of LH and testosterone secretion during sleep analogous to that seen during puberty. The clinical presentation of the fertile eunuch syndrome also bears some similarity to adult onset IHH in that both conditions are characterized by the occurrence of GnRH deficiency in association with normal or near-normal testicular size. However, "fertile eunuchs" are distinguished by the relative preservation of spermatogenesis and the achievement of fertility with testosterone or hCG therapy alone.

  2.3 Acquired        2.4.2 Delayed Puberty

Gerhard Leyendecker