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.