男性更年期症状を呈し低ゴナドトロピン性性腺機能低下症と診断された1例

Abstract

A 59-year-old male was referred to our hospital with chief complaints of general fatigue and muscle stiffness of the shoulders. His hormonal data were total testosterone 0.05 ng/ml (normal: 2.01-7.5 ng/ml), free testosterone less than 0.6 pg/ml, leuteinizing hormone (LH) 1.1 mIU/ml (2.2-8.4 mIU/ml), follicle stimulating hormone (FSH) 2.4 mIU/ml (1.8-12 mIU/ml) and prolactin (PRL) 13.1 ng/ml (4.3-13.7 ng/ml). Though both his genital stage and pubic hair stage were Tanner V, his testis volume was 12 ml on the right and 10 ml on the left. A gonadotropin releasing hormone (GnRH) stimulation test revealed low responses of LH and FSH. Magnetic resonance imaging of the head revealed pituitary tumor (15 mm). Our diagnosis was acquired hypogonadtropic-hypogonadism-related pituitary tumor. Transsphenoidal hypophysectomy was performed and pathological diagnosis revealed epidermoid cyst. Three months after the operation, his total testosterone was elevated to 1.17 ng/ml and his complaints were improved.

59歳男。易疲労感、頸部硬直感、食欲低下、体重減少で更年期障害を疑い更年期外来を受診した。総テストステロン、遊離テストステロンは低値でAging males' score(AMSスコア)は身体的因子(重症)、心理的因子6点(軽症)、性機能因子13点(重症)の合計44点(中等症)であった。テストステロン、 ゴナドトロピン値が共に低値で、身体的所見は外陰部、恥毛は共にTanner分類V度で、精巣容積は右10ml、左12mlと低容量であった。低ゴナドト ロビン性性腺機能低下症を疑い下垂体機能検査を実施し、GnRH負荷試験でLH、FSHは低反応を示した。頭部MRIはトルコ鞍から鞍上部にかけ径 15mm大の境界明瞭な腫瘤を認め、T1強調像で低信号、T2強調像で高信号を呈し、下垂体腫瘍に続発した低ゴナドトロピン性性腺機能低下症と診断し、脳 神経外科にて経蝶形骨洞腫瘍摘出術を施行した。病理所見はepidermoid cystで、内分泌所見は改善し、AMSスコアは合計スコア39点(中等度)で易疲労感、頸部硬直感も軽快した。