Saturday, May 28, 2016

Man With Kallmann Syndrome & Micropenis Responds to Testosterone

In a newly published study, researchers reported the case of a 26-year old man with Kallmann* syndrome and an abnormally small penis (micropenis) who gained more than half an inch when he started taking testosterone therapy.

The testosterone protocol increased the patient's serum testosterone and "resulted in a satisfactory gain in penile length" of 1.5 cm, according to Oscar Ruiz, MD, at the University of Puerto Rico. Ruiz presented the findings at a poster session in the annual meeting of the American Association of Clinical Endocrinologists.

"Testosterone treatment seems to be effective in patients with Kallmann Syndrome and micropenis. Thus, it may be the primary form of treatment for micropenis in adults with prepubertal characteristics." wrote the authors. 

The patient had no past medical history but he presented without ever having undergone puberty. According to Ruiz, his condition was first noticed at the age of 15, and he otherwise had normal developmental milestones. When Ruiz and his team examined him and reported a "eunuchoid body proportion," a 1-centimeter penis, a normal scrotum, and small testicles. The patient had no facial hair, sparse pubic hair, decreased libido, anosmia, and a high-pitched voice, but had a normal karyotype.

The authors reported that his hormone levels were consistent with hypogonadotropic hypogonadism
  • Follicle stimulating hormones = 1.27 mIU/mL 
  • Luteinizing hormones = 0.5 mIU/mL 
  • Total testosterone = 0.27 ng/mL 
  • Free testosterone = 0.007 ng/mL 
  • Sex hormone binding globulin = 13.7 nmol/L 

"Other pituitary hormones were within normal levels." wrote the authors. 
"When we were first questioning him we found out that he couldn't smell anything." said Ruiz in an interview. 

MRI examination later revealed that he did not have olfactory bulbs in his brain. A human chorionic gonadotropin test was done and the patient's plasma testosterone rose from 26 ng/dL to 69 ng/dL.

The patient's penis wasn't the only thing that got bigger. Changes to the testicles, which gained in volume, came after about 4 months. Ruiz says that he doesn't know whether further treatment will result in additional penile growth, but said findings from other studies indicate that sometimes treatment can result in a 4-centimeter gain. 

"The most important concern in a patient with micropenis is whether he will have sufficient penile growth to allow sexual function," wrote the authors. 

The team plans to continue to work with the patient so that he can eventually become fertile.

"Testosterone treatment seems to be effective in patients with KS and micropenis. It successfully increased serum testosterone level and resulted in a satisfactory gain in penile length. Thus, it may be the primary form of treatment for micropenis in adults with prepubertal characteristics." concluded the authors.

* Kallman syndrome: Kallmann syndrome is a genetic condition where the primary symptom is a failure to start puberty or a failure to fully complete it. It occurs in both males and females and has the additional symptoms of hypogonadism and almost invariably infertility. Kallmann syndrome also features the additional symptom of an altered sense of smell; either completely absent (anosmia) or highly reduced (hyposmia).

pictured is a small penis from a kallmann's patient
Photo of a Micropenis from a patient with Kallmann Syndrome
Source

References
- MedPageToday
- Ruiz O, et al "Penile growth in response to hormone treatment in an adult with micropenis and kallman syndrome" AACE 2016