Hypogonadism: The Daily PANCE Blueprint

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Hypogonadism: The Daily PANCE Blueprint

A 60-year-old male with a history of type 2 diabetes, obesity, and chronic obstructive pulmonary disease (COPD) presents with decreased energy levels, reduced muscle mass, and a low mood, persisting for the past year. He has children and reports no issues with fertility in the past. He also mentions experiencing difficulty in maintaining concentration. He is on long-term opioid therapy for COPD-related chronic pain. His diabetes is managed with oral hypoglycemics. Which of the following laboratory findings is most indicative of secondary hypogonadism in this patient?

A. Normal gonadotropins (LH/FSH) and normal testosterone
B. Elevated gonadotropins and low testosterone
C. Elevated gonadotropins and high testosterone
D. Reduced gonadotropins and low testosterone
E. Reduced gonadotropins and high testosterone

Answer and topic summary

The answer is D. Reduced gonadotropins and low testosterone

Secondary hypogonadism is characterized by low levels of testosterone due to a problem with the pituitary gland or hypothalamus, rather than a problem with the testes themselves. In this case, the patient’s symptoms of decreased energy, reduced muscle mass, and low mood, along with a history of chronic opioid use (which can affect the hypothalamic-pituitary-gonadal axis), suggest secondary hypogonadism. The appropriate laboratory finding indicative of this condition would be reduced gonadotropins (LH and FSH) and low testosterone, reflecting the under-stimulation of the testes due to decreased pituitary function.

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