Longitudinal Evaluation of Reproductive Endocrine Function in Men With ACTH-Dependent Cushing Syndrome

Area of Science:

• Endocrinology
• Reproductive Medicine
• Surgical Endocrinology

Background:

• Cushing syndrome (CS) can cause hypogonadism, worsening its effects.
• Assessing hypogonadism prevalence and causes in men with CS is crucial.

Purpose of the Study:

• Determine the frequency of male hypogonadism before and after surgical cure for CS.
• Investigate the underlying causes of hypogonadism in this patient population.

Main Methods:

• Post hoc analysis of two prospective cohorts (C1: n=8, C2: n=44) of men with ACTH-dependent CS.
• Hormonal assessments (LH, FSH, testosterone, thyroid hormones, cortisol) and GnRH stimulation tests pre- and post-surgery.
• Evaluation of hypogonadism frequency at baseline and 6, 12 months post-surgical cure.

Main Results:

• 82% of patients had baseline hypogonadism; 51% still had it at 6 months post-surgery, decreasing to 26% at 12 months.
• Testosterone and LH levels significantly increased post-surgery.
• Thyroid hormone levels inversely correlated with cortisol, and hypogonadism appears mediated by hypothalamic GnRH suppression.

Conclusions:

• Male hypogonadism is highly prevalent in CS but largely reversible within a year after successful surgery.
• Surgical cure of CS can restore testicular function, with recovery rates around 75% at one year.
• Hypogonadism in CS is linked to GnRH suppression and influenced by thyroid hormone status.