hypogodadic hypogonadism

A 21-year-old male is referred to the endocrine clinic with poorly developed secondary sexual characteristics. The only relevant finding on history is that he has a very poor sense of smell.

On examination he has no axillary or pubertal hair, a 3 cm penis and testicular volumes of approximately 5 ml bilaterally. Smell test reveals that he is unable to distinguish acetone and coffee.

Investigations reveal:

Testosterone 4 nmol/l (10-30)
Prolactin 380 mU/l (<450)
FSH 2.1 IU/l (1-7)
LH 1.5 IU/l (1-10)

What is the most likely diagnosis?

(Please select 1 option)

5-alpha reductase deficiency
Kallman’s syndrome This is the correct answerThis is the correct answer
Klinefelter’s syndrome
Microdeletion of the Y chromosome IncorrectIncorrect answer selected

This patient has evidence of hypogonadotrophic hypogonadism with a low testosterone and a low follicle-stimulating hormone (FSH) and luteinising hormone (LH). In this case, there is isolated gonadotrophic deficiency as evidenced by a normal prolactin. This is seen in Kallman’s syndrome, which is often associated with anosmia.

In Klinefelter’s syndrome an elevated LH/FSH would be expected, as this is due to testicular failure as would be the case in 5-alpha reductase deficiency.

Craniopharyngioma is a possibility as it does cause hypogonadotrophic hypogonadism but abnormalities in sense of smell would not be expected.

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thromlysis absolute contradiction

1 known and suspected arotic disssection,

2 major sugery/trauma  in 3w,

3 active internal bleeding (except menses),

4 CNS damage or tumor,

5 previous hemorrhagic stroke 

6 ischemic stroke in 6m,

7 diabetic proliferative rentinopathy,

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Turner syndrome

Bicuspid aortic valve,   Arotic coarctation



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Bicuspid aortic valve

sx occur after calcification inducing AS or AR

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Non bacterial thrombotic endocarditis

Marantic endocarditis

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-pan-systolic murmur: VSD, MR,

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