Couldn't this simply be testicular failure?
On the assumption that his albumin is around 40g/L, his calculated free testosterone is only 1.17 % (Ref range 2-3%) therefore his LH (FSH) are quite appropriate.
Regards
Ian
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of JONES Stuart (Pathology) (RF4) BHR Hospitals
Sent: 03 March 2011 14:58
To: [log in to unmask]
Subject: SHBG puzzle - ?partial androgen insensitivity
You may remember our interesting SHBG patient (original results below).
Further investigations and clinical examination have not uncovered a
specific cause of his raised SHBG and other endocrine abnormalities.
However, the endocrinologist noted that he has gynaecomastia and after a
quick spot of googling we decided we might be dealing a case of partial
androgen insensitivity:
http://www.nejm.org/doi/full/10.1056/NEJM197902013000503
Has anybody come across a similar case?
Does anybody know of an assay for dihydrotestosterone binding capacity?
Regards
Stuart
Stuart Jones
Senior clinical scientist
Queens Hosp
Romford
-----Original Message-----
From: Stuart Jones [mailto:[log in to unmask]]
Sent: 17 February 2011 12:38
To: [log in to unmask]
Cc: JONES Stuart (Pathology) (RF4) BHR Hospitals
Subject: SHBG puzzle
Some unusual hormone results for you to puzzle over:
35yo man presented in 2005 with testicular pain and ED, result from
urology referral (all immulite):
FSH 26.2 (0.7 - 11.1)
LH 12.4 (0.8 - 7.6)
Testo 19.0 (8.4 - 28.7)
SHBG - 78 (13 - 71)
Hormone results repeated at various times by primary care and
consistently showed the similar pattern but with LH/FSH apparently
increasing. Referred to endocrinology in Aug 2010; results (centaur
unless specified):
FSH - 43.3 (1.4 - 18.1)
LH - 38.6 (1.5 - 9.3)
TESTO - 23.2 ( 8.4-28.7)
SHBG (immulite) - 119 (13 - 71)
E2 - 145 ( <155)
Prolactin - 137 (45 - 375)
9am Cortisol - 569
TSH - 2.6
All results (except SHBG) confirmed by alternative methods at Birmingham
SAS lab (Testo by MS/MS - 28.4 (7 - 27).
Alpha subunits also measured and were negative
Free testo calculates at 0.80%, which I believe is slightly low (1.0-2.7
from Tietz)
Additional results from Jan endocrine OPD app:
ACa - 2.9
PTH - 7.9pmol/L (1.3 - 6.8)
ACE - 86 (15 - 70)
24 Ca excretion - 5.9 (2.5 - 7.5)
Total Vit D - 15nmol/l
Slight macrocytosis with low/normal folate
History shows high calcium (2.8-3.0) since at least 2008.
Other details:
Hypertensive - on ACEi
Mildly elevated cholesterol (5-6mmol/L) - Not currently on statin No
other meds Normal liver function Normal thyroid function Normal renal
function No evidence of pituitary disease/adenoma Denies exogenous
hormone ingestion and is not a frequent gym attender
It appears that the high SHBG is driving gonadotrophin production and
high testosterone but what could be the cause of this? Genetic variant
perhaps? Could the calcium be related or is this a red herring?
Thoughts/opinions greatly appreciated
Stuart Jones
Senior Clinical Scientist
Queen's Hosp
Romford
Barking, Havering & Redbridge University Hospitals NHS Trust: Most Innovative Trust in London 2009
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