Prevalence and outcome of secondary hypogonadism in male patients with Cushing's syndrome and mild autonomous cortisol secretion.
Level 3 - non-randomized controlled study
Non-randomized matched case-control comparison with longitudinal follow-up of a treated subgroup.
PubMed 39074212 · doi:10.1093/ejendo/lvae097
What was done
The study evaluated 30 treatment-naïve adult men with Cushing's syndrome (CS) and 17 men with mild autonomous cortisol secretion (MACS) diagnosed since 2012. Secondary hypogonadism was defined by total testosterone < 10.4 nmol/L and age-specific cut-offs. Testosterone levels were compared against age- and BMI-matched controls, and a longitudinal follow-up was performed in 20 men in remission from CS at 6, 12, and 24 months post-surgery.
What was found
Secondary hypogonadism was present at baseline in 93% of men with CS and 59% of men with MACS. Men with CS had significantly lower total testosterone, bioavailable testosterone, and free testosterone compared to controls (P < .0001), with the lowest values in ectopic CS; total testosterone was also significantly lower in MACS. Testosterone correlated negatively with late-night salivary cortisol and pre- and post-1 mg dexamethasone suppression test serum cortisol. Following successful surgery, total testosterone increased significantly (P = .001) and normalized within 6 months, though several red blood cell parameters remained low up to 2 years post-surgery.
Why it matters
The findings demonstrate that secondary hypogonadism is highly prevalent not only in overt Cushing's syndrome but also in mild autonomous cortisol secretion. It confirms that hypercortisolism-induced hypogonadism is typically reversible within months of biochemical remission.
Limits
The sample size is small (30 CS, 17 MACS, and 20 longitudinally followed patients), and the abstract does not report the exact number of matched controls. Specific baseline and follow-up numerical values for testosterone and red blood cell parameters are omitted from the abstract.
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