Hi Victoria,
The results of your patient are consistent with hypergonadotrophic hypogonadism (primary testicular failure) and the high SHBG (due to aging and hypogonadism) has kept total testosterone at lower part of normal range.
Regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, EurClinChem, FRCP Edin, FRCPath
Consultant Chemical Pathologist
--------------------------------------------
On Fri, 25/4/14, Clough Victoria (BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST) <[log in to unmask]> wrote:
Subject: Re: Interpretation of male gonadotrophins with normal testosterone
To: [log in to unmask]
Date: Friday, 25 April, 2014, 15:53
Dear all
We've recently had a case similar to the one Fiona described
- an 81 yr old male with diabetes who saw his GP for a
routine check-up and had tesosterone and gonadotrophins
requested to investigate erectile dysfunction:
FSH
46.8
iu/L (
1.4 - 18.1 )
LH
23.0
iu/L (
1.5 - 9.3 )
Testosterone 11.0
nmol/L ( 8.4 -
28.7)
Due to the unusual pattern of results SHBG was added on by
the lab and found to be raised, giving a low free
testosterone (calculated using http://www.issam.ch/freetesto.htm)
SHBG
138
nmol/L ( 13 - 71
)
Free testosterone 0.7%
Bioavailable testosterone 16.3%
We've yet to find an explanation for his raised SHBG.
TFTs were added to check for hyperthyroidism but TSH was
1.05 mU/L. He is taking co-codamol and a fibrate (and
presumably something for his diabetes but the GP didn't
mention this!) and liver function is normal. We'd be
interested in hearing any suggestions as to the cause of his
raised SHBG.
Vicky
Victoria Clough
Clinical Biochemist
Queen's Hospital
Barking, Havering and Redbridge University Hospitals NHS
Trust
________________________________________
From: Clinical biochemistry discussion list [[log in to unmask]]
On Behalf Of Fiona Davidson [[log in to unmask]]
Sent: 15 April 2014 17:32
To: [log in to unmask]
Subject: Interpretation of male gonadotrophins with normal
testosterone
Dear all,
We have recently had a coupleof slightly odd male LH and FSH
results in the context of erectile dysfunction with normal
total testosterone. I was wonder if the collective brain
could share their thoughts on how to interpret gonadotrophin
results in the absence of obvious primary or secondary
hypogonadism?
Patient 1:
44 y/o presenting with erectile dysfunction and prev history
of epilepsy (not clear what, if any current medication he is
on).
Total Testosterone = 22.7 nmol/L
FSH = 31 IU/L
LH = 28 IU/L
Prolactin = 135 mU/L
UE, LFTs, Lipids all normal. Above results were
confirmed on repeat.
Could this be due to anti-epileptic medication?
Patient 2:
27 y/o presenting with low libido and erectile dysfunction
and concerned RE fertility. Not on any medication or
supplements.
Total Testosterone = 15.3
FSH = < 1
LH = 3
Prolactin = 239
Oestradiol < 100
All results confirmed on repeat.
Normal UE, LFT, lipids.
SHBG was not measured for either of these patients as the
testosterone was well into the normal range in both cases.
All comments gratefully received!
Kind Regards
Fiona Davidson
Senior Clinical Biochemist
Kingston Hospital
------ACB discussion List Information--------
This is an open discussion list for the academic and
clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the
individual and they are responsible for all message
content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
********************************************************************************************************************
This message may contain confidential information. If you
are not the intended recipient please inform the
sender that you have received the message in error before
deleting it.
Please do not disclose, copy or distribute information in
this e-mail or take any action in reliance on its contents:
to do so is strictly prohibited and may be unlawful.
Thank you for your co-operation.
NHSmail is the secure email and directory service available
for all NHS staff in England and Scotland
NHSmail is approved for exchanging patient data and other
sensitive information with NHSmail and GSi recipients
NHSmail provides an email address for your career in the NHS
and can be accessed anywhere
********************************************************************************************************************
------ACB discussion List Information--------
This is an open discussion list for the academic and
clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the
individual and they are responsible for all message
content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|