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Adiposis, tonsillar hypertrophy and iatrogenic testosterone administration in a patient with obstructive sleep apnea

Adipositas, Tonsillenhypertrophie und iatrogene Testosteron-zufuhr bei einem Patienten mit obstruktiver Schlafapnoe

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Abstract

We report the case of a 24 year old patient with obstructive sleep apnea (OSA) who had undergone endocrinological testing for adiposis and arterial hypertension before maturity. Supposing a lack of 3-ß-hydroxysteriod dehydrogenase he was substituted with testosterone for several years. The time of admission in december 1994 we found a pathological glucose tolerance and a tonsillar hypertrophy, too. The formerly diagnosed variant of the adrenogenital syndrome could not be verified. Polysomnography revealed OSA and made us begin with nasal CPAP-therapy. During nasal ventilation support the patient started to loose weight. Testosterone administration was stopped. The tonsils remained in situ.

This case report of OSA demonstrates pathophysiological interactions and their therapeutical implications. Especially in young patients morphologically conspicuous findings and/or associated diseases are quite common. They should influence the therapeutical approach.

Zusammenfassung

Wir berichten über einen 24jährigen Patienten mit obstruktiver Schlafapnoe (OSA), bei dem wegen schon präpubertär vorhandener Adipositas und arterieller Hypertonie eine endokrinologische Abklärung vorgenommen worden war. Unter der Annahme eines 3-ß-Hydroxyste-rioddehydrogenasemangels wurde über mehrere Jahre Testosteron substituiert. Bei Aufnahme im Dezember 1994 zeigte sich außerdem eine pathologische Glucosetoleranz und eine deutliche Tonsillen- und Uvulahyperplasie. Die ehemals gefundene Variante des adrenogenitalen Syndroms ließ sich nicht bestätigen. Nach polysom-nographischer Sicherung der OSA wurde eine nCPAP-Therapie eingeleitet. Während der nCPAP-Therapie wurde dann eine Gewichtsreduktion durch den Patienten eingeleitet. Die exogene Testosteronzufuhr wurde gestoppt. Die Tonsillen verblieben in situ.

Anhand des Fallberichtes werden die für die Genese der OSA pathophysiologisch bedeutsamen Interaktionen und die sich daraus ergebenden therapeutischen Implikationen erläutert. Besonders bei jungen Patienten finden sich gehäuft auffällige, morphologische Befunde und Begleiterkrankungen, deren Therapie auch die OSA beeinflußt.

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Authors and Affiliations

  1. University ENT Clinic Mannheim, Germany

    J. Maurer, M. Hönig & K. Hörmann

  2. IV. Med. Univ. Clinic, Mannheim

    M. Juncker & C. Schubotz

Authors
  1. J. Maurer
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  2. M. Juncker
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  3. M. Hönig
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  4. C. Schubotz
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  5. K. Hörmann
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Maurer, J., Juncker, M., Hönig, M. et al. Adiposis, tonsillar hypertrophy and iatrogenic testosterone administration in a patient with obstructive sleep apnea. Sleep Breath 1, 24–31 (1996). https://doi.org/10.1007/BF03038943

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