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MRI And Its Correlation with Hypogonadotropic Hypogonadism

Discussion in 'Men's Health Forum' started by Michael Scally MD, Jun 8, 2019.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Das G, Surya A, Okosieme O, et al. PITUITARY IMAGING BY MRI AND ITS CORRELATION WITH BIOCHEMICAL PARAMETERS IN THE EVALUATION OF MEN WITH HYPOGONADOTROPIC HYPOGONADISM. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2019. An Error Occurred Setting Your User Cookie

    Objective: A significant ambiguity still remains about which patient deserves a MRI of the pituitary during evaluation of hypogonadotropic hypogonadism (HH) in men.

    Methods: Retrospective case series of 175 men with HH referred over 6 years.

    Results: 49.7% of men had total testosterone (TT) levels lower than the Endocrine Society threshold of 5.2 nmol/L. 142 patients (81.2%) had normal appearance of pituitary MRI whereas others had different spectrum of abnormalities [empty sella (n=16); macroadenoma (n=8); microadenoma (n=8) and pituitary cyst (n=1)]. In men with TT in the lowest quartile, MRI pituitary findings was not statistically different from men in the remaining quartiles (p=0.50).

    Patients with raised prolactin had higher number of abnormal MRI findings (38.9% vs. 13.7%; p = 0.0014) and adenomatous lesions (macro and micro) (27.8% vs. 4.3%; p = 0.01) in comparison to men with normal prolactin.

    The prolactin levels were highest in men with macroadenomas in both groups [9950 (915); p=0.007 and 300 (68.0) mU/L; p = 0.02 respectively] with concomitant lower level of other pituitary hormones. Multivariate logistic regression showed an association of abnormal pituitary MRI with igf-1 SDS [OR: 1.78 (95% CI, 1.15 - 2.77); p=0.009] and prolactin [OR: 1.00 (1.00 -1.03); p=0.01].

    Conclusion: MRI of pituitary is not warranted in all patients with HH as the yield of identifiable abnormalities is quite low. Anatomical lesions are likely to be present only when low levels of TT (<5.2 nmol/L) are found concomitantly with high levels of prolactin and/or low IGF-1 SDS scores.
     

    Attached Files:

    Millard Baker likes this.
  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Pituitary Adenomas

    What you need to know

    · Check visual fields in patients presenting with headache coexisting with possible hypopituitary symptoms
    · Consider the diagnosis in men with fatigue and ask about low libido or erectile dysfunction; check 9 am testosterone, prolactin, luteinising hormone (LH), and follicle stimulating hormone (FSH)
    · Consider the diagnosis in women with oligo/amenorrhoea; check LH, FSH, oestradiol, and prolactin

    A 58 year old man describes increasing fatigue and loss of motivation over a year. Routine blood tests are normal. He is going through a divorce and he and his GP agree that the symptoms are likely related to stress. On a routine eye check he is found to have a bitemporal hemianopia. Pituitary magnetic resonance imaging (MRI) reveals a 2.5 cm pituitary macroadenoma elevating and compressing the optic chiasm. On further questioning, the patient describes a four year history of erectile dysfunction.

    Pituitary adenomas are often clinically silent or manifest with non-specific symptoms, which can lead to a delayed diagnosis. This article provides a summary of clinical features and investigations to help non-specialists and primary care doctors to recognise and diagnose pituitary adenoma.

    How common are pituitary adenomas?

    · Pituitary adenomas are very common (up to 16% from autopsy and imaging studies) but only 0.1% progress to cause morbidity21
    · Previous population studies of pituitary adenomas have probably underestimated true prevalence. A community study of more than 80 000 inhabitants showed that prevalence of pituitary adenomas per 100 000 was fourfold higher than previous estimates at approximately 1:1000.22 Other population studies confirm this232425
    · From the third decade onwards, pituitary adenoma is the most common cause of an intrasellar mass

    Pal A, Leaver L, Wass J. Pituitary adenomas. BMJ (Clinical research ed) 2019;365:l2091. Pituitary adenomas
     

    Attached Files:

    Millard Baker likes this.
  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Pituitary Imaging by MRI and Its Correlation with Biochemical Parameters in The Evaluation of Men with Hypogonadotropic Hypogonadism

    Objective: A significant ambiguity still remains about which patient deserves a magnetic resonance imaging (MRI) scan of the pituitary during evaluation of hypogonadotropic hypogonadism (HH) in men.

    Methods: Retrospective case series of 175 men with HH referred over 6 years.

    Results: A total of 49.7% of men had total testosterone (TT) levels lower than the Endocrine Society threshold of 5.2 nmol/L. One-hundred forty-two patients (81.2%) had normal appearance of pituitary MRI, whereas others had different spectrum of abnormalities (empty sella [n = 16], macroadenoma [n = 8], microadenoma [n = 8], and pituitary cyst [n = 1]). In men with TT in the lowest quartile, MRI pituitary findings were not significantly different from men in the remaining quartiles (P = .50).

    Patients with raised prolactin had higher number of abnormal MRI findings (38.9% vs. 13.7%; P = .0014) and adenomatous lesions (macro and micro) (27.8% vs. 4.3%; P = .01) in comparison to men with normal prolactin. The prolactin levels (median [interquartile range]) were highest in men with macroadenomas in both groups (9,950 [915]; P = .007 and 300 [68.0] mU/L; P = .02, respectively), with concomitant lower levels of other pituitary hormones.

    Multivariate logistic regression showed an association of abnormal pituitary MRI with insulin-like growth factor 1 (igf-1) standard deviation score (SDS) (odds ratio [OR], 1.78 [95% confidence interval (CI), 1.15 to 2.77]; P = .009) and prolactin (OR, 1.00 [95% CI, 1.00 to 1.03]; P = .01).

    Conclusion: MRI of the pituitary is not warranted in all patients with HH, as the yield of identifiable abnormalities is quite low. Anatomic lesions are likely to be present only when low levels of TT (<5.2 nmol/L) are found concomitantly with high levels of prolactin and/or low IGF-1 SDS.

    Das G, Surya A, Okosieme O, et al. PITUITARY IMAGING BY MRI AND ITS CORRELATION WITH BIOCHEMICAL PARAMETERS IN THE EVALUATION OF MEN WITH HYPOGONADOTROPIC HYPOGONADISM. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2019;25:926-34. An Error Occurred Setting Your User Cookie
     
    Millard Baker likes this.