Previously Unrecognized Congenital Hypogonadotropic Hypogonadism in an 89-Year-Old Man: A Case Report.
- 1Internal Medicine, Unidade Local de Saúde de Castelo Branco, Castelo Branco, PRT.
Abstract
Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder typically recognized during adolescence because of absent or incomplete pubertal development. We report the case of an 89-year-old man admitted for an ischemic stroke whose physical examination revealed a high-pitched voice, markedly sparse facial and axillary hair, bilateral gynecomastia, a markedly reduced penile size clinically suggestive of micropenis, and nonpalpable testes in the scrotum. Hormonal evaluation showed a total testosterone concentration below 7.00 ng/dL, luteinizing hormone below 0.07 IU/L, and follicle-stimulating hormone of 0.83 IU/L, consistent with severe central hypogonadism. Ultrasonography demonstrated both testes within the inguinal canals with reduced testicular size. Magnetic resonance imaging (MRI) of the sellar region showed no structural hypothalamic-pituitary abnormality. Although advanced age and acute systemic illness may have contributed to further functional suppression of the hypothalamic-pituitary-gonadal axis, these factors could not account for the developmental genital abnormalities. Integration of the phenotypic, biochemical, and imaging findings supported a clinical diagnosis of previously unrecognized CHH. This case illustrates an exceptionally late recognition of CHH and highlights the diagnostic value of developmental phenotypic features in identifying a congenital disorder that may remain unrecognized for decades.
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BibTeX
@article{ferreira2026previously,
title = {{Previously Unrecognized Congenital Hypogonadotropic Hypogonadism in an 89-Year-Old Man: A Case Report.}},
author = {Mafalda Ferreira and Patrícia O Saraiva and Franciso Nunes and João Cardoso and Maria Eugénia André},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116742},
url = {https://europepmc.org/article/MED/42924005},
note = {CC BY},
}
RIS
TY - JOUR
TI - Previously Unrecognized Congenital Hypogonadotropic Hypogonadism in an 89-Year-Old Man: A Case Report.
AU - Mafalda Ferreira
AU - Patrícia O Saraiva
AU - Franciso Nunes
AU - João Cardoso
AU - Maria Eugénia André
PY - 2026
DA - 2026/09/22
JO - Cureus
DO - 10.7759/cureus.116742
UR - https://europepmc.org/article/MED/42924005
AB - Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder typically recognized during adolescence because of absent or incomplete pubertal development. We report the case of an 89-year-old man admitted for an ischemic stroke whose physical examination revealed a high-pitched voice, markedly sparse facial and axillary hair, bilateral gynecomastia, a markedly reduced penile size clinically suggestive of micropenis, and nonpalpable testes in the scrotum. Hormonal evaluation showed a total testosterone concentration below 7.00 ng/dL, luteinizing hormone below 0.07 IU/L, and follicle-stimulating hormone of 0.83 IU/L, consistent with severe central hypogonadism. Ultrasonography demonstrated both testes within the inguinal canals with reduced testicular size. Magnetic resonance imaging (MRI) of the sellar region showed no structural hypothalamic-pituitary abnormality. Although advanced age and acute systemic illness may have contributed to further functional suppression of the hypothalamic-pituitary-gonadal axis, these factors could not account for the developmental genital abnormalities. Integration of the phenotypic, biochemical, and imaging findings supported a clinical diagnosis of previously unrecognized CHH. This case illustrates an exceptionally late recognition of CHH and highlights the diagnostic value of developmental phenotypic features in identifying a congenital disorder that may remain unrecognized for decades.
SN - 2168-8184
ER -