Evaluation of the hypothalamic-pituitary-gonadal axis in males with systemic lupus erythematosus

To evaluate the hypothalamic-pituitary-gonadal axis in male patients with systemic lupus erythematosus (SLE).

We studied 7 male patients with SLE and compared them with 10 age matched healthy controls. Clinical data, laboratory tests, drugs used, and disease activity for SLE (SLE Disease Activity Index) were determined. The basal serum levels of cortisol, total testosterone (T), free testosterone (FT), androstenedione, dehydroepiandrosterone sulfate (DHEAS), estradiol (E2), prolactin (PRL), luteinizing hormone (LH), and follicle stimulating hormone (FSH) were measured in all individuals. In addition, response of LH and FSH to stimulation with luteinizing hormone releasing hormone (LHRH, 100 microg, intravenously) and response of T and FT to stimulation with human chorionic gonadotropins (HCG, 1500 u intramuscular for 3 days) were examined.

Patients with SLE had lower basal levels of T and FT than controls but this difference was not significant. DHEAS and A levels were significantly lower in patients than in controls. The low response of FT after stimulation with HCG indicated diminished testis function (mainly Leidyg cells). In contrast to other studies, the E2 level was significantly lower in patients than in controls. The groups did not differ in LH levels at baseline or after stimulation with LHRH. However, basal levels of FSH were significantly higher in patients.

These results suggest that the hypothalamic-pituitary-axis function was normal in patients with SLE. The testis had diminished function, shown by reduced response of FT to stimulation with HCG, but possible inhibitory effects of glucocorticoid therapy must be considered.