Effects of Clomiphene Citrate and Synthetic LHRH on Serum Luteinizing Hormone (LH) in Men with Idiopathic Hemochromatosis

Tourniaire, J; Fevre, Michelle; Mazenod, B; Ponsin, Gabriel

doi:10.1210/jcem-38-6-1122

Cited by 39 publications

(9 citation statements)

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“…This hypothesis was supported by the low PRL levels found in IHC in our study and by other investigations demonstrating multiple pituitary failure (1,(11)(12)(13)(29)(30)(31). This is in contrast to AC, where mainly testicular failure was found (2,4,(32)(33)(34).…”

Section: Discussionsupporting

confidence: 90%

Conversion of Androgens to Estrogens in Idiopathic Hemochromatosis: Comparison with Alcoholic Liver Cirrhosis*

Kley¹,

Niederau²,

Stremmel³

et al. 1985

The Journal of Clinical Endocrinology & Metabolism

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Hypogonadism is common in patients with some liver diseases, such as idiopathic hemochromatosis (IHC) and alcoholic cirrhosis (AC). However, gynecomastia, a typical feature in AC, does not occur in IHC. To determine the hormonal basis for this difference, the following parameters were determined in patients with IHC and AC as well as in normal men: plasma concentrations of androgens and estrogens, metabolic clearance and production rates of androstenedione and testosterone, and the contribution of peripheral conversion of androstenedione and testosterone to the circulating estrogens. Severe impotence in both patients with IHC and those with AC was associated with more than 50% reduction in plasma testosterone. The reduction was due to 63% and 70% decreases in testosterone production in IHC and AC, respectively. The MCRs were less affected in IHC and AC (19% and 37% reductions, respectively). In IHC, the fall in testosterone concentrations was accompanied by decreased production and plasma concentrations of androstenedione, a precursor for estrogen synthesis. In contrast, production and plasma concentrations of androstenedione were significantly increased in AC. Patients with IHC had estradiol und estrone levels similar to those in normal men (mean +/- SD, 16.2 +/- 4.6 vs. 20.3 +/- 3.7 pg/ml; P = NS), whereas in AC, estradiol and estrone were significantly elevated (38.0 +/- 5.3 and 68.5 +/- 17.2 pg/ml, respectively). In IHC, sex hormone-binding globulin levels were in the same range as in the normal men, whereas sex hormone-binding globulin was increased in AC. In IHC, the instantaneous contribution of plasma androstenedione to estrone and estradiol was normal, whereas that of plasma testosterone to plasma estrogens was decreased by about 50%. In contrast, in AC, the instantaneous contribution of plasma androstenedione to estrogens was greatly enhanced, and that of testosterone was in the normal range. Since the MCRs of androgens and the conversion ratios of androgens to estrogens indicate normal peripheral metabolism of sex hormones in IHC, decreased androgen formation implies decreased testicular synthesis. This was confirmed by a significantly decreased LH level in IHC (5.5 +/- 1.9 vs. 10.5 +/- 3.1 mU/ml in normal men), indicating pituitary failure. In AC, however, increased LH (20.0 +/- 2.7 mU/ml) may be indicative of primary testicular failure. These results confirm clinical features of hypogonadism and normal estrogenic activity in patients with IHC.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionsupporting

confidence: 90%

Conversion of Androgens to Estrogens in Idiopathic Hemochromatosis: Comparison with Alcoholic Liver Cirrhosis*

Kley¹,

Niederau²,

Stremmel³

et al. 1985

The Journal of Clinical Endocrinology & Metabolism

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“…Most hypogonadal men with hemochromatosis have hypogonadotropic hypogonadism and only occasionally is the hypogonadism gonadal in origin (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Consistent with these findings autopsy studies have shown that the anterior pituitary gland, especially the gonadotrophs, usually contain stainable iron, sometimes in massive amounts (3,15).…”

Section: Discussionmentioning

confidence: 84%

“…H YPOGONADISM is the most common endocrine dysfunction in men with hemochromatosis (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The hypogonadism usually results from FSH/LH or GnRH deficiency (pituitary or hypothalamic), which is believed to be due to iron-induced damage of the pituitary gonadotrophs or of the hypothalamic cells secreting GnRH (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

mentioning

confidence: 99%

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Hypogonadotropic Hypogonadism in Hemochromatosis: Recovery of Reproductive Function After Iron Depletion

Siemons

Mahler

1987

The Journal of Clinical Endocrinology & Metabolism

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We studied the effect of iron depletion on reproductive function in a 37-yr-old man with hypogonadotropic hypogonadism due to idiopathic hemochromatosis. Before therapy, he was impotent and had no libido, and seminal fluid analysis revealed no spermatozoa. Testicular biopsy showed marked impairment of spermatogenesis, but no iron load deposits. Sixteen months after institution of aggressive phlebotomy therapy, serum LH, FSH, and testosterone were normal, and potency and libido had returned. Twenty months after diagnosis the patient fathered another child. Seminal fluid analysis at that time revealed an average of 65 million spermatozoa/mL. Thus, recovery of reproductive function, documented by hormone measurements, testicular biopsy, and semen analysis, was complete. We conclude that phlebotomy alone may be adequate treatment for hypogonadotropic hypogonadism in men with hemochromatosis.

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“…This opinion is supported by histopathologic studies that have demonstrated iron deposits in the hypophysis 29 and studies on gonadotropic function, disturbed in most patients. 30 Growth hormone secretion in primary or secondary hemochromatosis has been studied. 16 " 18 In eight patients with IH (overt diabetes in seven and glucose intolerance in one) arginine-induced plasma GH response was said to be high in six patients and low in PHILIPPE PASSA, M .…”

Section: Blood Glucose Mg/100ml |-150mentioning

confidence: 99%

Retinopathy and Plasma Growth Hormone Levels in Idiopathic Hemochromatosis with Diabetes

et al. 1977

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In patients with idiopathic hemochromatosis, retinopathy was investigated by ophthalmoscopy and fluorescein angiography and was present in eight out of 23; this prevalence is similar to that reported in patients with diabetes aged between 30 and 60 years at onset of diabetes and with the same duration of the disease; in these eight patients retinopathy was of mild degree, with no impairment of visual acuity, fewer than 10 microaneurysms in each fundus, and no other retinal abnormatic islets directly. These studies confirm that anticholinergic drugs may be useful adjuvants in treating these patients.

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Effects of Clomiphene Citrate and Synthetic LHRH on Serum Luteinizing Hormone (LH) in Men with Idiopathic Hemochromatosis

Cited by 39 publications

References 0 publications

Conversion of Androgens to Estrogens in Idiopathic Hemochromatosis: Comparison with Alcoholic Liver Cirrhosis*

Conversion of Androgens to Estrogens in Idiopathic Hemochromatosis: Comparison with Alcoholic Liver Cirrhosis*

Hypogonadotropic Hypogonadism in Hemochromatosis: Recovery of Reproductive Function After Iron Depletion

Retinopathy and Plasma Growth Hormone Levels in Idiopathic Hemochromatosis with Diabetes

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