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Kallmann syndrome fertility planning — SCE Endocrinology MCQ

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HardReproductive endocrinologyKallmann syndrome fertility planningSCE Endocrinology

A 25-year-old man has delayed puberty, anosmia and unilateral renal agenesis. Testosterone is low with low LH and FSH. MRI shows absent olfactory bulbs. He wants fertility in future. What is the most appropriate management?

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Correct answer: A — Testosterone for virilisation now and gonadotrophin or pulsatile GnRH therapy when fertility is desired

Testosterone for virilisation now and gonadotrophin or pulsatile GnRH therapy when fertility is desired is best because Kallmann syndrome causes congenital GnRH deficiency; testosterone virilises but does not induce spermatogenesis. The alternatives are less appropriate because fertility needs gonadotrophin or pulsatile GnRH therapy; orchidectomy is irrelevant; hydrocortisone does not restore GnRH; anosmia is not a prolactinoma sign. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: Endocrine Society hypogonadism guidance