[Acquired male hypogonadotropic hypogonadism (MHH) in a patient with empty sella: a case report]

A 40-year-old unmarried male was referred to our hospital with anejaculation. His secondary sex characteristics, sexual function and ejaculation were previously normal but for the last 5 years he found it impossible to ejaculate even though he could achieve an erection. His genital stage was Tanner V, and pubic hair stage was Tanner III. There were no varicoceles or chromosomal aberrations. His testis volume was 10 ml on the right side and 12 ml on the left. His hormonal data were luleinizing hormone (LH) 0.3 mIU/ml (normal: 2.2-8.4 mIU/ml), fillicle stimulating hormone (FSH) 1.5 mIU/ ml (1.8-12 mIU/ml), testosterone 0.05 ng/ml (2.01-7.5 ng/ml). A gonadtropin releasing hormone (GnRH) test and human chorionic gonadotropin (hCG) stimulation test revealed low responses of LH, FSH and a normal response of testosterone. Magnetic resonance imaging of the head revealed slight depression of the diaphragma sellae, indicating an "empty sella". We diagnosed acquired hypogonadtropic-hypogonadism related empty sella. An hCG replacement therapy was introduced and after 3 months the patient's capacity to ejaculate was restored and testis volume was 14 ml on both sides. Six months after hormone replacement therapy, semen analysis revealed azoospermia. Then we added r-hFSH to his treatment and expect his sperm to reappear.