Congenital adrenal hyperplasia causing male infertility. Report of one case Alteración de la fertilidad masculine por hiperplasia suprarrenal congénita. Azoospermia reversible con terapia de glucocorticoide

Abstract

In males, congenital adrenal hyperplasia due to 21 hydroxylase defi ciency is associated to normal fertility or infertility caused by a hypogonadotrophic hypogo-nadism (HH) or gonadal damage caused by intratesticular adrenal remnants. We report a 29-year-old male with azoospermia, without any important personal or family background. Physical examination was normal, his height was 150 cm and his testicular volume was 10 ml (normal 15 to 25 ml). Laboratory showed a normal testosterone and FSH and LH in the low normal limit. These results discarded a HH, whose diagnostic requirements are a low testosterone and inadequately normal or low gonadotrophins. A testicular biopsy was informed as compatible with HH. A 21 hydroxylase defi ciency was suspected and confi rmed with extremely high levels of 17 hydroxyprogesterone at baseline and after stimulation with fast acting ACTH. Clomiphene citrate did not increase testosterone or gonatrophin levels. Testicular ultrasound discarded the presence o