The Development of Hypogonadotropic Hypogonadism After Starting Low Dose Mifepristone for Cushing’s Syndrome

Abstract Background: Mifepristone is an antiprogesterone that has been studied in females and shown central effects including suppressing LH surges. There a paucity of information about how it males. Clinical Case: 65-year-old male with bilateral adrenal macronodular hyperplasia noted on past surveillance CT scan presented to endocrinology. He had history coronary artery disease, type 2 diabetes, obesity, treated sleep apnea. progressively worsening abdominal weight gain, supraclavicular fat pads, thin bruising skin, hypertension. several abnormal 1 mg overnight dexamethasone suppression tests (ACTH 3 & <1 pg/ml cortisol 10 ug/dL 11.1 ug/dL). midnight salivary (109 ng/dL, 147ng/dL, 152 reference <100 ng/dL). elected have medical treatment for his Cushing’s Syndrome after hypertension episodes hypertensive urgency. was deemed non-surgical candidate. started mifepristone 300 mg/day spironolactone 12.5 given eGFR 47 mL/min/1.73sq m. His dose dropped every other day he orthostatic hypotension, nausea, hot flashes. On lower mifepristone, control improved without hypotension or nausea. flashes remained developed breast enlargement tenderness. A repeat testosterone found be low, but the rest evaluation gynecomastia negative otherwise. pre-treatment am 281 ng/dL (normal 250–1100 ng/dL) post level <7 ng/dL. suppressed gonadotrophins (LH <0.2 mIU/mL; normal 1.4–7.77 mIU/mL, FSH 2.5–17.1 mIU/mL), prolactin (PRL 11 ng/mL; 2.6–12 ng/mL) pituitary MRI. Conclusion: This first case demonstrating severe hypogonadotropic hypogonadism using low mild ACTH independent Syndrome. Reference: Escudero, E. et al. Is Effective Oral Alternative Prevention Premature Luteinizing Hormone Surges and/or Luteinization Women Undergoing Controlled Ovarian Hyperstimulation Vitro Fertilization. J Clin Endocrinol Metab. 2005; 90(4):2081–2088.