A patient of hypogonadotropic hypogonadism accompanied by growth hormone deficiency and decreased bone mineral density who attained normal growth

We present here a rare case of hypopituitarism accompanied by growth hormon e (GH) deficiency and hypogonadotropic hypogonadism, in which the patient a ttained normal height but was of eunuchoid appearance, A W-year-old man who had not reached puberty was referred to Saitama Medical School for hormona l evaluation. Basal hormonal data and hormone-stimulating tests revealed im paired secretion of GH, gonadotropins and adrenocorticotropic hormone (ACTH ). Serum levels of testosterone, estrone, estradiol and estriol were all be low the detectable ranges, The patient's plasma ACTH responded to corticotr opin releasing hormone, but not to insulin-induced hypoglycemia, Serum GH s howed a minimal response to GH-releasing hormone, but was unresponsive to i nsulin-induced hypoglycemia, Serum luteinizing hormone and follicle stimula ting hormone did not respond to luteinizing hormone-releasing hormone. The results were compatible with a diagnosis of hypothalamic hypopituitarism. M agnetic resonance images of the brain showed a small anterior pituitary, an ectopic posterior lobe and transection of the pituitary stalk. Although th e patient showed signs of hypopituitarism, he finally attained normal heigh t, possibly because of failed epiphyseal maturation. His bone mineral densi ty was markedly reduced to 0.647 g/cm(2) in the lumbar spine; this level wa s 61.7% of the average level of healthy young males. Our findings were comp atible with a recently advocated view that estrogen is important in promoti ng epiphyseal fusion and in determining bone density in males as well as fe males.