Pituitary imaging findings in male patients with hypogonadotrophic hypogonadism

Hirsch, Dania; Benbassat, Carlos; Toledano, Yoel; S’chigol, Irena; Tsvetov, Gloria; Shraga-Slutzky, Ilana; Eizenberg, Yoav; Shimon, Ilan

doi:10.1007/s11102-014-0601-x

Cited by 10 publications

(13 citation statements)

References 34 publications

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“…The role of total T as a hallmark of possible pathologic MRI findings in secondary hypogonadal patients has been previously considered by a limited number of studies [8,[14][15][16][17][18][19] and, among these, only one have recognized a threshold for total T [8]. This latter study has the value to have attempted a formal approach for establishing a threshold, by evaluating the difference in the frequency of abnormal computed tomography (CT) or MRI findings among total T quintiles.…”

Section: Discussionmentioning

confidence: 99%

Biochemical predictors of structural hypothalamus–pituitary abnormalities detected by magnetic resonance imaging in men with secondary hypogonadism

Cipriani

Todisco

Ghiandai

et al. 2021

J Endocrinol Invest

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Purpose Organic conditions underlying secondary hypogonadism (SH) may be ascertained by magnetic resonance imaging (MRI) of the hypothalamic–pituitary region that could not be systematically proposed to each patient. Based upon limited evidence, the Endocrine Society (ES) guidelines suggest total testosterone (T) < 5.2 nmol/L to identify patients eligible for MRI. The study aims to identify markers and their best threshold value predicting pathological MRI findings in men with SH. Methods A consecutive series of 609 men seeking medical care for sexual dysfunction and with SH (total T < 10.5 nmol/L and LH ≤ 9.4 U/L) was retrospectively evaluated. An independent cohort of 50 men with SH was used as validation sample. 126 men in the exploratory sample and the whole validation sample underwent MRI. Results In the exploratory sample, patients with pathological MRI findings (n = 46) had significantly lower total T, luteinizing hormone (LH), follicle stimulating hormone (FSH) and prostate specific antigen (PSA) than men with normal MRI (n = 80). Receiver Operating Characteristics analysis showed that total T, LH, FSH and PSA are accurate in identifying men with pathologic MRI (accuracy: 0.62–0.68, all p < 0.05). The Youden index was used to detect the value with the best performance, corresponding to total T 6.1 nmol/L, LH 1.9 U/L, FSH 4.2 U/L and PSA 0.58 ng/mL. In the validation cohort, only total T ≤ 6.1 nmol/L and LH ≤ 1.9 U/L were confirmed as significant predictors of pathologic MRI. Conclusion In men with SH, total T ≤ 6.1 nmol/L or LH ≤ 1.9 U/L should arise the suspect of hypothalamus/pituitary structural abnormalities, deserving MRI evaluation.

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Section: Discussionmentioning

confidence: 99%

Biochemical predictors of structural hypothalamus–pituitary abnormalities detected by magnetic resonance imaging in men with secondary hypogonadism

Cipriani

Todisco

Ghiandai

et al. 2021

J Endocrinol Invest

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“…In addition, we found no differences in the frequency of low gonadotropin levels, type of amenorrhea, or presence of secondary sex characteristics when comparing patients with space-occupying lesions and those with normal pituitary MRI results. To date, several studies have reported the diagnostic usefulness of pituitary MRI in patients with HH; however, all of these studies were performed in male patients with hypogonadism [13141516]. To the best of our knowledge, this was the first study to present the frequency of pituitary MRI abnormalities and associated factors in female patients with HH.…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis of large space-occupying lesions in the H-P area is important, because some of the lesions can lead to neurologic sequelae such as bitemporal hemianopia or unilateral optic atrophy due to the compression of the optic chiasm or optic nerve tracts. Reassuringly, however, studies performed in male patients with HH showed a low frequency of clinically significant macroadenoma in the H-P area (0–2.4%) [13141516]. In 1996, a prospective study of 164 male patients with HH demonstrated the prevalence of total H-P imaging abnormalities and pituitary macroadenoma to be 6.7% (11/164) and 2.4% (4/164), respectively [13].…”

Section: Discussionmentioning

confidence: 99%

“…The most useful imaging modality to date for the diagnosis of H-P abnormalities is pituitary magnetic resonance imaging (MRI) [12]; however, because testing is expensive and structural pituitary abnormalities occur at a low frequency, there have been debates regarding whether pituitary MRI should be performed in the routine evaluation of patients with HH [1314]. Nonetheless, a few studies have reported the efficiency of pituitary MRI in male patients with HH [13141516], although strategies for determining the necessity of pituitary MRI remain inconclusive. Furthermore, there has been a lack of information regarding the indications for pituitary imaging in female patients with HH.…”

Section: Introductionmentioning

confidence: 99%

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Pituitary magnetic resonance imaging abnormalities in young female patients with hypogonadotropic hypogonadism

Kang

Kim

et al. 2019

Obstet Gynecol Sci

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Objective To elucidate the association between clinical and laboratory characteristics and pituitary magnetic resonance imaging (MRI) abnormalities in young female patients with hypogonadotropic hypogonadism (HH). Methods We retrospectively investigated a series of 74 female patients (age range, 14–42 years) with normoprolactinemic HH who underwent pituitary MRI. Pubertal milestones and hormonal features of patients with small pituitary glands (PGs) and space-occupying lesions were compared with those of patients with normal PGs. Results The overall frequency of abnormal PGs was 35.1%, with space-occupying lesions observed in 8 patients (10.8%), and small PG observed in 18 patients (24.3%). The mean serum gonadotropin level was not different between patients with and without pituitary MRI abnormalities ( P >0.05). Space-occupying lesions were not associated with low gonadotropin levels, type of amenorrhea, or presence of secondary sex characteristics. The frequency of space-occupying lesions was higher in patients with interrupted puberty (25.0%) than in patients who did not go through puberty (4.8%) or had a normal puberty (9.8%), but were not statistically significant ( P >0.05). Small PG was associated with low gonadotropin levels and type of amenorrhea ( P <0.05). Conclusion Clinically significant space-occupying lesions were not associated with low gonadotropin levels, type of amenorrhea, or presence of secondary sex characteristics. However, the frequency of space-occupying lesions was higher in patients with interrupted puberty than in patients who did not go through puberty or who with normal puberty.

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“…Pituitary “incidentalomas”, usually 6 mm diameter or less, are present on magnetic resonance imaging (MRI) in about 10% of the general population, and silent adenomas are found in up to 20% of autopsies (54). In our opinion pituitary MRI, preferably with and without contrast, should be performed in men with secondary hypogonadism who meet one of the following criteria (19,55-57): severe secondary hypogonadism (total testosterone level <150 ng/dL) with FSH and LH levels below normal, signifying a higher risk of pituitary pathology, persistent hyperprolactinemia, symptoms of headache or visual defects, or in the event that any other pituitary hormones are deficient on biochemical analysis.…”

Section: The Role Of Pituitary Imagingmentioning

confidence: 99%

Testosterone replacement therapy: role of pituitary and thyroid in diagnosis and treatment

Crawford

Kennedy

2016

Transl. Androl. Urol.

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Crosstalk among hormones characterizes endocrine function, and assessment of the hypogonadal man should take that into consideration. In men for whom testosterone deficiency is a concern, initial evaluation should include a thorough history and physical exam in which other endocrinopathies are being considered. Hypogonadism can be associated with both pituitary and thyroid dysfunction, for which appropriate biochemical evaluation should be undertaken in certain clinical scenarios. If low serum testosterone is confirmed measurement of luteinizing and follicle stimulating hormones (LH and FSH respectively) is essential to establish whether the hypogonadism is primary or secondary. In secondary hypogonadism measurement of prolactin is always necessary, and measurement of other pituitary hormones, along with pituitary imaging, may be indicated. Checking thyroid function may also be enlightening, and can raise additional therapeutic considerations. Correction of other pituitary axes may attenuate the need for testosterone replacement therapy in some cases.

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Pituitary imaging findings in male patients with hypogonadotrophic hypogonadism

Cited by 10 publications

References 34 publications

Biochemical predictors of structural hypothalamus–pituitary abnormalities detected by magnetic resonance imaging in men with secondary hypogonadism

Biochemical predictors of structural hypothalamus–pituitary abnormalities detected by magnetic resonance imaging in men with secondary hypogonadism

Pituitary magnetic resonance imaging abnormalities in young female patients with hypogonadotropic hypogonadism

Testosterone replacement therapy: role of pituitary and thyroid in diagnosis and treatment

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