Severe diabetic ketoacidosis (DKA) may be complicated by primary testicular failure.
Mechanism: probably diffuse ischemic injury secondary to severe hypotension; also consider systemic infection
Clinical features:
(1) severe diabetic ketoacidosis with severe hypotension
(2) decrease in testicular volume
(3) marked decrease in serum testosterone (hypogonadism)
(4) elevated serum LH and FSH (hypergonadotropic)
(5) decreased serum inhibin B
(6) reduction in spermatogenesis
Diagnosis requires exclusion of:
(1) secondary testicular failure (due to hypopituitarism)
(2) exclusion of other causes of primary testicular failure such as Klinefelter syndrome and autoimmune polyglandular syndrome
