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CLINICAL CASE SEMINAR |
Consultorios Asociados de Endocrinologia (L.M., G.T.), 1425 Buenos Aires, Argentina; Tomografia Computada Buenos Aires-TCBA (C.A., M.V.), 1425 Buenos Aires, Argentina; Department of Internal Medicine, Chair of Endocrinology (V.R., C.C.), University of Modena and Reggio Emilia, 41100 Modena, Italy; Jean Hailes Foundation (S.D.), Clayton, Australia; and Prince Henry’s Institute of Medical Research (Y.M., C.D.C., E.R.S.), Victoria 3168 Clayton, Australia
Address all correspondence and requests for reprints to: Professor Cesare Carani, Chair of Endocrinology, Department of Internal Medicine, University of Modena and Reggio, Emilia, Policlinico Via del Pozzo, 71, 41100 Modena Italy. E-mail: carani.cesare{at}unimo.it.
We present the fourth case of an adult man (29 yr old) affected by aromatase deficiency resulting from a novel homozygous inactivating mutation of the CYP19 (P450arom) gene. At first observation, continuing linear growth, eunuchoid body proportions, diffuse bone pain, and bilateral cryptorchidism were observed. The patient presented also a complex dysmetabolic syndrome characterized by insulin resistance, diabetes mellitus type 2, acanthosis nigricans, liver steatohepatitis, and signs of precocious atherogenesis. The analysis of the effects induced by the successive treatment with high doses of testosterone, alendronate, and estradiol allows further insight into the roles of androgens and estrogens on several metabolic functions. High doses of testosterone treatment resulted in a severe imbalance in the estradiol to testosterone ratio together with the occurrence of insulin resistance and diabetes mellitus type 2. Estrogen treatment resulted in an improvement of acanthosis nigricans, insulin resistance, and liver steatohepatitis, coupled with a better glycemic control and the disappearance of two carotid plaques. Furthermore, the study confirms previous data concerning the key role of estrogens on male bone maturation, at least in part, and regulation of gonadotropin secretion. The biopsy of the testis showed a pattern of total germ cell depletion that might be due to the concomitant presence of bilateral cryptorchidism. Thus, a possible role of estrogen in male reproductive function is suggested but without revealing a direct cause-effect relationship.
Data from this case provide new insights into the role of estrogens in glucose, lipid, and liver metabolism in men. This new case of aromatase deficiency confirms previous data on bone maturation and mineralization, and it reveals a high risk for the precocious development of cardiovascular disease in young aromatase-deficient men.
This work was supported by United States Public Health Service Grant R-37AG08174-14 from the National Institute on Aging and by Ministero dell’Università e della Ricerca Scientifica (fondi 60%).
Abbreviations: ArKO, Aromatase knockout; BMD, bone mineral density; BMI, body mass index; GOT, glutamic oxaloacetic transaminase; GPT, glutamic pyruvic transaminase; 
-GT, -glutamyl-transferase; HbA1c, glycosylated hemoglobin; HDL, high-density lipoprotein; LDL, low-density lipoprotein; NASH, nonalcoholic steatohepatitis.
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