interesting Q about hypothalamus dysfunction and cirrhosis

[JS67]

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The Q is like: male, 50y/o, has developed gynecomastia and small firm testes, low TSH, LOW T3 T4, what is the cause?

I think about hypothalamic-pituitary-adrenal (gonadal) axis dysfunction, then low hypopituitarism and low testosterone; but my friend thinks cirrhosis and liver failure. We know cirrhosis leads to gynecomastia, small testes, LOW T3 T4 (low albumin, Low T3, T4, if not free T3, 4), but then TSH should be up due to negative feedback. Any input about? Thanks

 

[Rendar5]

yeah, the low TSH makes it sound like it's a pituitary issue and not a liver issue.

 

[waster]

it wouldn't be liver unless there was some relevant history given: alpha-1, booze, etc.

 

[JS67]

That's what I think, but just I am not sure about gynecomastia in hypothalamus dysf. If low LH, FSH lead to low testosterone and "estrogen", where the gynecomastia comes from in male ? Thanks

 

[butaloh666]

Or it could just be a prolactinoma squeezing out thyrotropes (low TSH and low T3/T4), squeezing out gonadotropes (low LH/FSH and shriveled cojones), and producing very high prolactin levels which can cause gynecomastia in severe cases.

 

[docmd2010]

certainly is a hypothalamus-pituitary issue. cirrhosis is known to cause disturbances in this axis and can most def. cause hypofunction.

i'm not really sure why, but we had a patient with this and our attending said the exact etiology isn't known but may have something to do with zinc insensitivity and according to Uworld, the "false production of neurotransmitters"

 

[JS67]

certainly is a hypothalamus-pituitary issue. cirrhosis is known to cause disturbances in this axis and can most def. cause hypofunction.

i'm not really sure why, but we had a patient with this and our attending said the exact etiology isn't known but may have something to do with zinc insensitivity and according to Uworld, the "false production of neurotransmitters"

It makes sense. I checked UW, as you said, hypothalamus dys and cirrhosis frequently show up together. The mechanism is not really clear. 🙄

Thanks for all replies above

 

[Scaredshizzles]

The Q is like: male, 50y/o, has developed gynecomastia and small firm testes, low TSH, LOW T3 T4, what is the cause?

I think about hypothalamic-pituitary-adrenal (gonadal) axis dysfunction, then low hypopituitarism and low testosterone; but my friend thinks cirrhosis and liver failure. We know cirrhosis leads to gynecomastia, small testes, LOW T3 T4 (low albumin, Low T3, T4, if not free T3, 4), but then TSH should be up due to negative feedback. Any input about? Thanks

Sounds like hemochromatosis might be what they were getting at.

 

[medInUSA]

That's what I think, but just I am not sure about gynecomastia in hypothalamus dysf. If low LH, FSH lead to low testosterone and "estrogen", where the gynecomastia comes from in male ? Thanks

Any man with cirrhosis gets gynecomastia regardless of hypothal/pit dysfunction.

Androgens and estrogens are metabolized in the liver, so if the liver is shot there are more androgens circulating (and they get converted to estrogens by fatty tissue peripherally), also your adrenals produce estrogens which are now not being degraded properly in the liver.

same reason why men get telangiectasias.

 

[medInUSA]

I also remember struggling with this question for a while