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Background. Patients with acromegaly (caused by growth-hormone-secreting pituitary adenomas) are at increased risk of hypopituitarism, in particular hypogonadotropic hypogonadism, before and after multimodal therapy. In affected women of reproductive age, fertility is impaired and complex fertility treatments are needed to achieve conception. case presentation. We present the case of a young woman with acromegaly caused by a GH-secreting macroadenoma with suprasellar and bilateral cavernous sinus extension; hypogonadotropic hypogonadism and secondary hypothyroidism were present from the initial evaluation. Neurosurgical intervention was repeatedly recommended but the patient refused it initially; also she was non-compliant to the medical treatment of acromegaly. Transsphenoidal tumor debulking with adjuvant gamma-knife radiotherapy was eventually performed. Following treatment persistent active acromegaly and hypogonadotropic hypogonadism were diagnosed. Under chronic estroprogestative replacement therapy, the patient conceived and delivered a full-term healthy newborn without any complications. Possible mechanisms are discussed. conclusions. Secondary hypogonadotropic hypogonadism in pituitary patients, even when considered permanent (after surgery and radiotherapy), can exceptionally allow spontaneous conception and normal course of pregnancy.

Introduction: Bilateral testicular regression syndrome (TRS) is a very rare condition characterized by the absence of testicular tissue in a genotypic male. Case report: A 39 years old male with TRS (diagnosed at age 8, during investigation for bilateral cryptorchidism) associating paranoid schizophrenia (diagnosed at the age of 14) is described. The patient received parenteral androgen replacement only for a few months in the pubertal period. After puberty, the psychiatric team strongly advised against the androgen replacement which was stopped and not resumed ever since. At presentation the patient has no subjective complaints but clear signs of hypogonadism. The psychiatric status was stable under neuroleptics. Topical androgen replacement was recommended but it aggravated the psychotic aggressive features so it was stopped. Conclusion: We present the case of a patient with TRS associating, from early adolescence, a severe psychiatric pathology with aggressive characteristics, which constantly precluded adequate testosterone replacement.