Investigative procedures

Persistent hypothalamic-pituitary insufficiency following acute meningoencephalitis. A report of two cases

This report concerns two patients, a 43-year-old woman and a 53-year-old man, who developed clinical as well as laboratory signs of permanent gonodal and thyroid failure following an acute intracranial infection--in the woman a meningoencephalitis of unknown origin, and in the man an encephalitis caused by Coxsackie B5. Endocrine investigations were compatible with hypothalamic-pituitary dysfunction, with some of the results favoring a hypothalamic lesion. Perhaps hormone deficiency of hypothalamic and/or pituitary origin is a more common sequel of acute meningoencephalitis than has hitherto been reported.

The role of the laboratory in the investigation of infertility

The incidence and the causes of the various types of infertility in men and women are described. Accurate diagnosis of the cause or causes of a couple's infertility is important as the treatment is often expensive and lengthy. A thorough clinical investigation of the couple will indicate which laboratory tests to embark upon. Endocrine abnormalities may account for about a third of diagnoses in women but are rare in men. Standard immunoassay procedures are used for hormone assays to diagnose endocrinopathies and should be performed in a logical sequence. They help to identify hyperprolactinaemia and to distinguish primary gonadal failure from lesions of the hypothalamic-pituitary axis. The common drugs available for treatment are listed and guidelines are given on management during treatment. Hormone assays are useful, but ultrasonic scanning is efficient and rapid and is becoming the preferred method for monitoring follicular growth.

Pituitary-testicular reserve in men with low serum testosterone and normal serum luteinizing hormone

Men with low serum testosterone levels who do not have elevated serum LH levels are generally thought to have hypothalamic-pituitary dysfunction. To evaluate this concept, seven men with a combination of low serum testosterone and normal serum LH underwent standard tests of hypothalamic-pituitary-testicular reserve. Pituitary reserve, tested with LHRH, showed exaggerated responses in two subjects, low-normal responses in one subject, and normal responses in the remaining four. Testing of hypothalamic-pituitary reserve with clomiphene showed normal gonadotropin responses in six subjects and blunted response in one (the same subject with the low LHRH response). Direct stimulation with hCG showed normal percentage increases in testosterone but low absolute levels, comparable to responses in patients with Klinefelter's syndrome. However, 17-OH-progresterone responses to hCG were lower in these subjects than in either controls or subjects with Klinefelter's syndrome. During follow-up, one subject developed frank primary testicular failure. It was concluded that men with low serum testosterone but normal serum LH are a heterogeneous group, and this pattern occasionally reflects early primary testicular failure rather than hypothalamic-pituitary dysfunction. Standard tests of pituitary-testicular reserve are generally not useful in defining abnormal hormonal output, although measurement of the 17-OH-progesterone response to hCG may improve their diagnostic utility.

Isolated FSH deficiency in a male. A case report

This report describes the case of a 26-year-old man investigated because of infertility. The patient appeared healthy with normal sexual activity, physical appearance and karyotype. Repeated semen analyses showed a marked oligozoospermia. A testicular biopsy specimen revealed arrested spermatogenesis and normal Leydig cells. Hormone analyses were normal except for a markedly reduced serum FSH level. Only a few such cases have been previously reported.