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Fig. 1 | Basic and Clinical Andrology

Fig. 1

From: Testicular impairment in Primary Adrenal Insufficiency caused by Nicotinamide Nucleotide Transhydrogenase (NNT) deficiency - a case report: implication of oxidative stress and importance of fertility preservation

Fig. 1

Changes in the hypothalamic-pituitary-axis and glucocorticoid axis between 1997 and 2017. The glucocorticoid axis is represented by ACTH levels. Higher ACTH levels are observed in the patient’s early twenties and thirties, which can be explained by the patient’s lack of compliance with medication and dietary measures during this period. The ACTH levels were undetectable during intensified glucocorticoid therapy (green arrows). The serum total testosterone levels started to decrease in the patient’s thirties, associated with higher gonadotrophin levels. The intensified glucocorticoid therapy did not contribute to an increase in the serum total testosterone levels. After TESE (purple arrow), an androgen substitution therapy was introduced (blue arrow), which led to a negative feedback on the pituitary–gonadal axis, with low gonadotrophin and serum total testosterone levels. ACTH: Adrenocorticotropic hormone, FSH: Follicle-stimulating hormone IU/L: international units per liter, LH: Luteinizing hormone, nmol/L: nanomole per liter, pmol/L: picomoles per liter, TESE: Testicular sperm extraction, y–o: year-old

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