Vanishing Testes Syndrome-Related Vertebral Fractures and High Cardio-Metabolic Risk in an Adult Male with Long Term Untreated Hypergonadotropic Hypogonadism

s 441 P48 Vanishing Testes Syndrome-Related Vertebral Fractures and High Cardio-Metabolic Risk in an Adult Male with Long Term Untreated Hypergonadotropic Hypogonadism Mara Carsote; C.I.Parhon National Institute of Endocrinology, Carol Davila University of Medicine and Pharmacy Anda Dumitrascu, Corina Chirita, Sorin Paun, Dana Terzea, Catalina Poiana Background: The hypogonadism-related bone mass loss despite its frequency among male osteoporosis cases it is often under diagnosed. The peak bone mass is severely affected if the hypogonadism is registered and left untreated during puberty. Aim: We present an interesting, almost bizarre case of a male who presented non-functional testes early during childhood and remained hypogonadic up to his fifth decade of life since no testosterone therapy was added during this time. Case presentation: A 46-year old male is referred for goiter evaluation. He accuses back pain. The phenotype resembled intersexuality: gynoid proportions, micropenis, no palpable testes into the scrotum, no face hair. His medical history revealed since last year: mixedema treated with levothyroxine, and ischemic heart disease with an episode of acute angina. On admission, the testosterone was 0.2 ng/mL (normal: 1.7-7.8 ng/mL), FSH of 56 mUI/mL, normal adrenal axis, as well as TSH (under substitution) were found. The bone turnover markers were twice as normal. High blood cholesterol and impaired glucose tolerance was registered. The thyroid ultrasound pointed a left lobe node of 1 cm. The testes were not found into the scrotum. Computed tomography suggested bilateral nodes of 1.6 cm into abdominal fat that were removed but no gonads were confirmed. Vanishing testes syndrome was confirmed. The central DXA pointed lumbar Bone Mineral Density (BMD) of 0.905 g/cm2, T-score of -2.8, and Z-score of -2.9. The spine profile X-Ray pointed thoracic vertebral multiple fractures. Alendronate therapy together with vitamin D and calcium supplements, as well as testosterone gel was started. Conclusion: Severe and long time standing hypogonadism affects not only the cardiac risk, as well as the skeleton integrity. Figure 1. BMD Z-scores in males and females with Addison’s disease P49 TSH Threshold Related to Lower Bone Mineral Density in Postmenopausal Patients Under TSH Suppression Therapy for Differentiated Thyroid Carcinoma Aline Farias; University of Campinas Ludmila Almeida, T.G. Melo, L.V.M. Assumpc~ao, Allan Santos, D.E. Zantut-Wittmann Introduction: TSH suppression with supraphysiological doses of levothyroxine aims to reduce risk of recurrence in the treatment of patients with differentiated thyroid carcinoma (DTC) after surgery and radioiodine therapy. Exogenous subclinical thyrotoxicosis (EST), with suppressed TSH and normal T4 levels probably has a negative effect on bone metabolism, but there is no definition of the magnitude of the effect on bone mineral density (BMD). Objective: To evaluate the relationship between TSH suppressive therapy in patients with DTC and BMD. Methods: Cross-sectional study of 109 postmenopausal women in EST followed for DTC, compared to the control group (postmenopause women with normal levels of thyroid hormones) matched for age. All participants were submitted to BMD examination and statistical data analysis was performed. Results: Mean age of patients was 58.4 ( 8.3) years, with menopause for 11.2 ( 9.5) years. The average of follow up for CDT was 88 ( 70.6) months, mean BMI 27.9 ( 4.5) kg/m, mean of TSH during the year before of BMD analysis was 0.21 ( 0.28) mUI / ml and mean of free T4 was 1.84 ( 0.21) ng / dL. Mean T-score was -1.09 (SD 1.43) in L1-L4 and -0.12 (SD 1.18) in the total femur, with 19.2% of patients with osteoporosis; 40.4% with osteopenia and 40.4% with normal BMD. There were no significant differences between T and Z-score values of patients and control group. Multivariate logistic regression analysis identified significant relationship between BMI (p !0.001; R2 0,15) and mean TSH level during the last year (p 5 0.021 and R2 0,0423) with lumbar BMD. There were also relationships between BMI (p !0.001; R2 0,26), TSH level (p !0.001; R2 0,07) and oral contraceptive use (p 5 0.007; R2 0,04) with femoral BMD of patients. The ROC curve analysis for TSH values that differentiate patients with normal BMD of those with osteopenia identified as significant threshold when TSH was inferior to 0,185_UI / ml (area under the significant curve: AUC 5 0.625, 95%, CI 0.50-0.74, p 5 0.04). Journal of Clinical Densitometry: Assessment & Management of Muscu Conclusions: The identification of a TSH threshold level in patients with DTC and EST maintaining normal BMD from those with osteopenia is unprecedented (to our knowledge). This may be of great importance to define the degree of TSH suppression in the follow-up of DTC. This is the rational to maintain TSH levels less suppressed in patients with low risk of recurrence or mortality, in order to preserve BMD in these patients. P50 Bone Mineral Density in Patients with Addison’s Disease on Replacement Therapy with Prednisolone David Chandy; Sanjay Gandhi Postgraduate Institute of Medical Sciences