Prevalence of Hypothalamic-Pituitary Imaging Abnormalities in Impotent Men with Secondary Hypogonadism

Citron, John T.; Ettinger, Bruce; Rubinoff, Howard; Ettinger, Vivian M.; Minkoff, Jerome R.; Hom, F. G.; Kan, Patricia B.; Alloo, Robert

doi:10.1097/00005392-199602000-00033

Cited by 17 publications

(22 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Eleven potentially serious hypothalamic or pituitary lesions were identified (6.7%). Men with macroadenomas all had TT < 1.04 ng/mL, but some men with smaller pituitary adenomas had higher levels ( [58], EBMl3b). Secondary TD may also require to screen for hemochromatosis with measurement of transferrin saturation and in the case it is increased with serum ferritin then testing for HFE mutation.…”

Section: Biochemical Diagnosis Of Tdmentioning

confidence: 97%

Testosterone Deficiency in Men: Systematic Review and Standard Operating Procedures for Diagnosis and Treatment

Buvat¹,

Maggi

Guay

et al. 2013

The Journal of Sexual Medicine

236

252

View full text Add to dashboard Cite

Introduction Testosterone (T) deficiency (TD) may significantly affect sexual function and multiple organ systems. Aim To provide recommendations and Standard Operating Procedures (SOPs) based on best evidence for diagnosis and treatment of TD in men Methods Medical literature was reviewed by the Endocrine subcommittee of the ISSM Standards Committee, followed by extensive internal discussion over two years, then public presentation and discussion with other experts Main Outcome Measure Recommendations and SOPs based on grading of evidence-based medical literature and interactive discussion Results TD is the association of a low serum T with consistent symptoms or signs. T level tends to decline with age. T modulates sexual motivation and erection. It also plays a broader role in men's health. Recent studies have established associations between low T, male sexual dysfunctions and metabolic risk factors. Though association does not mean causation, low T is associated with reduced longevity, risk of fatal cardiovascular events, obesity, sarcopenia, mobility limitations, osteoporosis, frailty, cognitive impairment, depression, Sleep Apnea Syndrome, and other chronic diseases. The paper proposes a standardized process for diagnosis and treatment of TD, and updates the knowledge on T therapy (Tth) and prostate and cardiovascular safety. There is no compelling evidence that Tth causes prostate cancer or its progression in men without severe TD. Polycythemia is presently the only cardiovascular-related adverse-event significantly associated with Tth. But follow-up of controlled T trials is limited to 3 years Conclusions Men with sexual dysfunctions, and/or with visceral obesity and metabolic diseases should be screened for TD and treated. Young men with TD should also be treated. Benefits and risks of Tth should be carefully assessed in older men. Prospective, long-term, placebo-controlled, interventional studies are required before screening for TD in more conditions, including cardiovascular diseases, and considering correction of TD as preventive medicine.

show abstract

Section: Biochemical Diagnosis Of Tdmentioning

confidence: 97%

Testosterone Deficiency in Men: Systematic Review and Standard Operating Procedures for Diagnosis and Treatment

Buvat¹,

Maggi

Guay

et al. 2013

The Journal of Sexual Medicine

236

252

View full text Add to dashboard Cite

show abstract

“…Assessment of pituitary function and evaluation of the local topography in the pituitary and hypothalamic region with imaging (magnetic resonance imaging, MRI) is clearly indicated if testosterone levels are very low, i.e. Ͻ5 nmol/l and LH levels below the mid-reference range according to the local laboratory [3,14,15]. If there is a suspicion of pituitary failure gonadotropin levels that are low, not present or lower than expected for the level of testosterone, which often is below 5 nmol/l, should raise the suspicion of hypothalamic or pituitary hypogonadism.…”

Section: Evaluation Of Suspicious Secondary Hypogonadismmentioning

confidence: 99%

Current Guidelines for the Diagnosis of Testosterone Deficiency

Arver

Lehtihet²

2008

Frontiers of Hormone Research

View full text Add to dashboard Cite

Hypogonadism in males is a clinical syndrome complex which comprises symptoms with or without signs as well as biochemical evidence of testosterone deficiency. The diagnosis of hypogonadism thus includes both clinical history and examination as well as biochemical assessment of serum testosterone levels. Hypogonadal symptoms depend on the age at onset of hypogonadism, severity of the deficiency, its duration and sensitivity to androgen action. Prepubertal onset results in lack of virilization and pubertal development and produces features such as eunuchoid body proportions and undeveloped secondary sex characteristics. Development of hypogonadism in adult life is characterized by a loss of androgen-dependent functions such as reduction in muscle mass, a shift in body composition towards more adipose tissue, decreased sexual function with diminished libido, depressed mood, loss of psychological energy osteoporosis and several other possible symptoms. The majority of men who suffer from hypogonadism do not have classical endocrine disorders. These men present with concomitant disease such as metabolic syndrome or type 2 diabetes, chronic infections, inflammatory disease, COPD, or cardiovascular disease. All these conditions are associated with a high prevalence of hypogonadism. Pharmacological therapy with opiates and corticosteroids are also known to cause hypogonadism. Hypogonadal symptoms are precipitated at different testosterone levels. Total testosterone levels of less than 8 nmol/l highly support a diagnosis of hypogonadism whereas levels greater than 12 nmol/l are likely to be normal. The grey zone between 8 and 12 nmol/l requires further evaluation and assessment of free or non-sex hormone-binding globulin-bound (bioavailable) testosterone. A trial period of testosterone treatment may be required.

show abstract

“…However, there are many other causes of secondary hypogonadism. Thus, in a CT/MRI study of 164 impotent males with low serum testosterone values pathology in the hypothalamo–pituitary region was found in only 11 patients (Citron et al ., 1996).…”

Section: Results Of Literature Searchmentioning

confidence: 99%

Neurosexology

Lundberg¹,

Ertekin²,

Ghezzi³

et al. 2001

Euro J of Neurology

View full text Add to dashboard Cite

Background Sexual function can be altered in patients by many neurological disorders affecting the cerebrum, the brain stem, the spinal cord, the spinal roots or the peripheral nerves. It can also be prominently affected in patients with an underlying undiagnosed neurological disease. Traditionally, practising neurologists have not paid much attention to sexual dysfunction in their patients, partly because therapeutic possibilities were scant. Sexual dysfunction, however, is observed in many neurological disorders, and may arise as a primary neurogenic disorder. Although not as obviously limiting as, for instance, paresis and pain, it is most disruptive for patients' lives. With emerging awareness of the primary importance of quality of life as the most important indicator of good patient management, and with the advent of more effective treatment of sexual dysfunction, it is no longer acceptable to ignore this very important dimension of life. In this review we will present the anatomical and physiological basis of the sexual response, the clinical approach to patients with sexual dysfunction, the characteristics of symptoms in neurological disorders, how to take a case history, diagnostic procedures and the treatment possibilities.

show abstract

Prevalence of Hypothalamic-Pituitary Imaging Abnormalities in Impotent Men with Secondary Hypogonadism

Abstract: The risk of hypothalamic or pituitary imaging abnormalities is low among men evaluated for erectile dysfunction and secondary hypogonadism. However, this risk increases markedly when the serum testosterone level is markedly decreased.

Cited by 17 publications

References 19 publications

Testosterone Deficiency in Men: Systematic Review and Standard Operating Procedures for Diagnosis and Treatment

Testosterone Deficiency in Men: Systematic Review and Standard Operating Procedures for Diagnosis and Treatment

Current Guidelines for the Diagnosis of Testosterone Deficiency

Neurosexology

Contact Info

Product

Resources

About