Dtsch Med Wochenschr 2013; 138(16): 831-833
DOI: 10.1055/s-0033-1343099
Kasuistik | Case report
Endokrinologie
© Georg Thieme Verlag KG Stuttgart · New York

Wie harmlos sind Kopfbälle? Hypogonadotroper Hypogonadismus nach leichten Schädel-Hirn-Traumata bei einem Profi-Fußballspieler

Isolated gonadotropic deficiency after multiple concussions in a professional soccer player
M. Auer
1   Abteilung für Innere Medizin, Endokrinologie und Diabetes, Max-Planck-Institut für Psychiatrie, München
,
G. K. Stalla
1   Abteilung für Innere Medizin, Endokrinologie und Diabetes, Max-Planck-Institut für Psychiatrie, München
,
A. P. Athanasoulia
1   Abteilung für Innere Medizin, Endokrinologie und Diabetes, Max-Planck-Institut für Psychiatrie, München
› Author Affiliations
Further Information

Publication History

22 November 2012

10 January 2013

Publication Date:
15 April 2013 (online)

Zusammenfassung

Anamnese und klinischer Befund: Ein 27-jähriger Patient stellte sich wegen zunehmender Erschöpfbarkeit, Libidoverlust und Erektionsstörungen vor. Er war seit 10 Jahren Profi-Fußballspieler und hatte seit dem 7.  Lebensjahr wiederholt milde Schädel-Hirn-Trauma (SHT) erlitten, die insbesondere durch intensives Kopfballtraining und gelegentliche Zusammenstöße bedingt waren.

Untersuchungen: Laborchemisch ließen sich niedrige Werte für Testosteron und Lutenisierendes Hormon (LH) im Sinne eines hypogonadotropen Hypogonadismus nachweisen. Ein darauffolgender Gonadotropin-Releasing-Hormon (GnRH)-Stimulationstest zeigte eine regelrechte Stimulierbarkeit der Gonadotropine, sodass eine hypophysäre Ursache unwahrscheinlich war. Weitere hormonelle Ausfälle wurden u. a. im Rahmen eines Insulin-Hypoglykämie-Tests ausgeschlossen. Eine MRT-Aufnahme des Schädels erbrachte keinen pathologischen Befund.

Therapie und Verlauf: Nach Rücksprache mit der Nationalen Anti-Doping-Agentur wurde eine Substitutionstherapie mit transdermalem Testosteron eingeleitet, die im Verlauf auf eine Langzeitsubstitution mit Testosteron-undecanoat umgestellt wurde. 4 Monate nach Therapiebeginn hatten sich die meisten der Symptome vollständig zurückgebildet.

Folgerung: Schädel-Hirn-Traumata sind eine häufige Ursache für isolierte Störungen der hypothalamisch-hypophysären Funktion. Dabei sollten auch wiederholte leichte Traumata ohne Bewusstseinsverlust, wie sie insbesondere bei körperbetonten Sportarten häufig auftreten können, in die differenzialdiagnostischen Erwägungen mit einbezogen werden.

Abstract

History and clinical presentation: A 27-year-old man was admitted to our outpatient clinic with symptoms of loss at libido, erectile dysfunction and fatigue. He had been playing soccer from the age of 7, for the last 10 years as a high-level professional. During that time repeated mild head-trauma without loss of consciousness had occurred, mainly triggered by excessive header-training and occasional collisions.

Investigations: Serum levels of testosterone and luteinizing hormone were low. A gonadotropin releasing hormone loading test revealed significant gonadotropin responses, therefore pituitary gonadotropic insufficiency was unlikely. Further pituitary insufficiency of any other axis was also excluded by insulin hypoglycemia test. Magnetic resonance imaging of the brain revealed no significant abnormalities of the hypothalamic-pituitary unit.

Treatment and course: Testosterone substitution, at first applied transdermally, then intramuscularly, was initiated after approval by the National Anti Doping Agency. Four months later most of the symptoms had regressed.

Conclusion: Pituitary deficiency in the course of craniocerebral trauma is frequent and may be transient or permanent, mostly affecting somatotropic or gonadotropic function. Hormonal imbalances may also be observed after mild but repeated trauma without loss of consciousness and should be considered in cases of isolated pituitary dysfunction, since such traumas may often occur in contacts sports such as boxing or intensive soccer play.

 
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