Paper #1
Case 1:
Medical history:
Lifelong hyperhydrosis on mild exertion
Spontaneous ejaculations
Lifelong premature ejaculation
Stuttering, and allergy to penicillin.
Findings:
Eugonadism
Total Testosterone 14.8 nmo1/1 (ref 8.3–34.0 nmo1/1)
SHBG 20 nmo1/1 (ref 20–55 nmo1/1)
LH 3.2 U/1 (ref: 1.5–12.0)
FSH 4.6 U/1 (ref: 2.0–8.0)
PSA 0.4 µg/1 (ref < 4.0 µg/1)
Case 2:
Medical history:
Hyperhidrosis on exertion
Right-sided seminoma testis at the age of 25, for which a hemicastration was performed, followed by radiotherapy.
At the age of 45, he developed, quite suddenly, spontaneous ejaculations, which were triggered mostly by stress and mechanical stimuli (car driving) and never associated with sexual arousal.
Findings:
Overweight (body-mass in- dex 31 kg/m2)
Scant beard growth
Loss of pubic and axillary hair
Bilateral gynecomastia
Abdominal obesity
The consistency of the remaining testicle was weak, and the volume was 8 ml
Primary testicular insufficiency
Total testosterone 8 nmo1/1 (ref. 8.3–34 nmo1/1)
Free testosterone 30 pmo1/1 (ref.: 45–108 pmo1/1)
Dehydroxytestosterone 0.62 nmo1/1 (ref: 0.90–3.70 nmo1/1)
LH 5.7 U/1 (ref: 1.5–12.0)
FSH 25.8 U/1 (ref: 2.0–8.0)
prolactine 210 mU/1 (ref: 75–275 mU/1)
Paper #2
History:
He had two psychiatric assessments in 1981 and 1996, and three neurological assessments in 1996 and 1997, with a tertiary referral being made to the national Hospital for Neurological Diseases. He has been fully investigated with 24 h electroencephalogram (EEG), magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) scans of the brain and numerous blood tests. No abnormality or reason for his symptoms could be elucidated.
Investigation:
Progesterone concentrations were measured from the patient during his wife’s second pregnancy. These were taken at approximately 6, 8, 11, and 15 weeks into his wife’s pregnancy. All the results were either at 1 nmol/l or at undeterminable values below this.
Paper #3
Medical history:
57-year-old-male noticing gradual onset of POIS symptoms during last 6 years.
He does not report any similar symptoms while exercising.
The only other situation in which he has experienced similar symptoms is following excessive alcohol ingestion.
Irritable bowel syndrome
Hypercholesterolemia
Occasional use of amyl nitrate
His father died at age 59 of a myocardial infarction.
His mother died at age 86 with dementia.
Investigation:
Physical examination: Normal, Euthymic
Blood: Renal function normal, liver function normal, creatine kinase normal, full blood count normal, thyroid function normal, prolactin normal, testosterone 11.3 nmol/L, SHBG 16 (15–30), HIV negative, syphilis serology negative
ECG: Sinus rhythm nil abnormal
Blood pressure: 136/82 lying, 128/76 standing
MRI brain: Nil abnormal discovered
Autonomic testing: Prone to vasovagal attacks, e.g., after hot bath, No evidence of sympathetic vasoconstrictor or cardiac parasympathetic failure
EEG: Normal
Consulted neurology colleagues, and they found the patient to be neurologically normal. Their opinion was that his symptoms may be due to a chronic fatigue-like illness.
