Amiodarone Associated Hypogonadism; An Under Appreciated Twist To An Old Foe

Presentation Number: SAT-292
Date of Presentation: March 17, 2018, 2018

Brittani McClain Breaux, Medical Doctorate1, Gabriel Ikponmosa Uwaifo, MD2.
1Ochsner Clinic Foundation, New Orleans, LA, USA, 2Ochsner Medical Foundation, New Orleans, LA, USA.

Abstract

Background; Amiodarone is a widely used antiarrhythmic agent with a long half life, narrow therapeutic window, and numerous potential adverse effects. The association of amiodarone with testicular dysfunction is, however, both underappreciated and under recognized. We present 4 cases of amiodarone associated hypogonadism. Clinical Case series; Four patients were seen over a 3.5 year period with features of hypergonadotrophic hypogonadism in the setting of amiodarone use. The patients were ages 70-76 years old, and all had chronic atrial fibrillation treated with amiodarone. Three patients had thyroid dysfunction - two with hypothyroidism on hormonal replacement and the other with toxic nodular disease with hyperthyroidism. Only one patient had gynecomastia. All had been on amiodarone therapy for over 3 years. Only one patient was referred specifically with hypogonadal complaints. During the initial evaluation, all patients had low total testosterone levels associated with elevated FSH and LH levels. Subsequent testicular ultrasounds of three of the subjects yielded various findings including multiple cysts and hydroceles, diffuse microlithiasis, and non specific scrotal calcifications. The mean amiodarone dose was 200mg daily; however, all patients had markedly elevated serum iodine levels despite low values of amiodarone and N-desethyl amiodarone when measured. Two patients had normalization in testosterone levels after stopping amiodarone over a period of six months to one year, while one commenced androgen repletion therapy. Concluding remarks; Amiodarone can be associated with direct testicular toxicity that can result in clinical hypogonadism which can be reversible in some cases. The potential impact of the medication on sperm function, quality and fertility is unclear. It is also unclear whether this toxicity is the result of the medication and its metabolites and/or a consequence of its associated iodine excess. Further studies are needed to define the prevalence of this adverse effect, evaluate if it has any impact on ovarian function, and identify factors that may increase individual risk for this adverse effect. References; Amiodarone and sexual dysfunction. Ahmad S. Am Heart J. 1995 Dec;130(6):1320-1. Testicular dysfunction with amiodarone use. Dobs AS, Sarma PS, Guarnieri T, Griffith L. J Am Coll Cardiol. 1991 Nov 1;18(5):1328-32. Amiodarone induced epididymitis: a case report. Cicek T, Cicek Demir C, Coban G, Coner A. Iran Red Crescent Med J. 2014 Jan;16(1):e13929. doi: 10.5812/ircmj.13929. Epub 2014 Jan 5.

Disclosures

 B.M. Breaux: None. G.I. Uwaifo: None.