DOI: 10.12890/2024_004726
Gynaecomastia revealing amiodarone-induced hypergonadotropic hypogonadism: an overlooked complication?
Authors
lynda_bombil1988@hotmail.com
Keywords
Amiodarone, hypergonadotropic hypogonadism, gynaecomastia, testicular dysfunction, epididymitisAbstract
We report a case of primary hypogonadism induced by amiodarone and review the relevant literature. Amiodarone has a well-established and extensive profile of side effects including thyroid toxicity, corneal deposits and skin discoloration. In rare cases, epididymitis or orchitis may occur. This inflammation can lead to testicular atrophy, inducing primary hypogonadism. We present the case of a 57-year-old patient, treated with amiodarone for several years, initially presenting with testicular pain followed by gynaecomastia, and finally loss of libido indicative of hypergonadotropic hypogonadism. Imaging confirmed bilateral testicular atrophy. Amiodarone was discontinued, and androgen replacement therapy was initiated. This case, combined with data from the literature, highlights the importance of careful monitoring of patients on amiodarone to identify symptoms or clinical signs suggesting testicular dysfunction, to diagnose and treat consequent hypogonadism.
References
- Nikolaou M, Ikonomidis I, Lekakis I, Tsiodras S, Kremastinos D. Amiodarone-induced epididymitis: a case report and review of the literature. Int J Cardiol 2007;121:e15–e16.
- Shen Y, Liu H, Cheng J, Bu P. Amiodarone-induced epididymitis: a pathologically confirmed case report and review of the literature. Cardiology 2014;128:349–351.
- Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method of estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30: 239–245.
- Ammoury A, Michaud S, Paul C, Prost-Squarcioni C, Alvarez F, Lamant L, et al. Photodistribution of blue-gray hyperpigmentation after amiodarone treatment: molecular characterization of amiodarone in the skin. Arch Dermatol 2008;144:92–96.
- Dobs AS, Sankara Sarma P, Guarnier T, Griffith L. Testicular dysfunction with amiodarone use. J Am Coll Cardiol 1991;18:1328–1332.
- Corona G, Goulis DG, Huhtaniemi I, Zitzmann M, Toppari J, Forti G, et al. European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males. Andrology 2020;8:970–987.