THE UTILITY OF PITUITARY MAGNETIC RESONANCE IMAGING IN MEN WITH SECONDARY HYPOGONADISM
AACE ePoster Library. Santoso C. 05/13/15; 97780; 806
Cong Santoso
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Abstract
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Objective: In men with secondary hypogonadism, the utility of routinely obtaining a magnetic resonance imaging (MRI) to exclude hypothalamic-pituitary pathology is not well studied. Hypogonadism is strongly associated with the metabolic syndrome (MetS) and type 2 diabetes (T2DM) however the exact mechanism is unknown. We performed a retrospective cohort study to evaluate the yield of pituitary MRI in men with secondary hypogonadism. We also determined if there were endocrinologic or hypothalamic-pituitary differences between men with and without metabolic syndrome (MetS) and/or type 2 diabetes (T2DM)
Methods: We performed retrospective chart review of men who received MRI of the brain during evaluation for hypogonadism. Baseline total testosterone (TT), free testosterone (FT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) were collected. We determined if men had the metabolic syndrome or diagnosis of type 2 diabetes mellitus. Statistical analysis was performed using Mann-Whitney test for continuous variables and Fisher’s exact test for categorical variables
Results: Eighty-eight men were included in the study, 16 (18%) had abnormal MRI. Pituitary adenoma was found in 9 (10%) men, and empty-sella was found in 7 (8%) men. Men with pituitary adenoma had significantly lower FT levels compared to men with normal MRI (18.7 pg/ml vs. 36.4 pg/ml). Men with empty-sella had significantly higher PRL compared to men with normal MRI (21.4 ng/ml vs. 11.2 ng/ml). Most men (80%) had MetS/T2DM. No endocrinologic differences were found between men with and without MetS /T2DM. Men without MetS/T2DM had higher incidence of abnormal MRI than men with MetS/T2DM (28% vs 16%), but this difference was not significant (p=0.30).
Discussion: The Endocrine Society’s current guidelines for pituitary imaging in evaluation of secondary hypogonadism is based on 2 urological studies. Pituitary imaging is recommended in severe secondary hypogonadism (TT<150ng/dl), panhypopituitarism, hyperprolactinemia, or symptoms or signs of tumor mass effect. The incidence of pituitary adenomas or empty-sella syndrome found in our study was not greater than the prevalence of these in the general population, indicating that there is little value to routinely obtain MRI in the evaluation of men with secondary hypogonadism. Pituitary adenoma and empty-sella syndrome are associated with very low FT and high prolactin levels, respectively. The higher (but not significant) incidence of pituitary abnormalities in men without MetS/T2DM may suggest greater utility of pituitary imaging in this group.
Conclusion: We do not recommend the use of MRI for routine evaluation of all men with secondary hypogonadism. MRI is warranted in men with higher PRL or very low FT, both of which are associated with pituitary structural abnormalities. Further research is needed to define pituitary MRI abnormalities and men without MetS/T2DM.
Methods: We performed retrospective chart review of men who received MRI of the brain during evaluation for hypogonadism. Baseline total testosterone (TT), free testosterone (FT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) were collected. We determined if men had the metabolic syndrome or diagnosis of type 2 diabetes mellitus. Statistical analysis was performed using Mann-Whitney test for continuous variables and Fisher’s exact test for categorical variables
Results: Eighty-eight men were included in the study, 16 (18%) had abnormal MRI. Pituitary adenoma was found in 9 (10%) men, and empty-sella was found in 7 (8%) men. Men with pituitary adenoma had significantly lower FT levels compared to men with normal MRI (18.7 pg/ml vs. 36.4 pg/ml). Men with empty-sella had significantly higher PRL compared to men with normal MRI (21.4 ng/ml vs. 11.2 ng/ml). Most men (80%) had MetS/T2DM. No endocrinologic differences were found between men with and without MetS /T2DM. Men without MetS/T2DM had higher incidence of abnormal MRI than men with MetS/T2DM (28% vs 16%), but this difference was not significant (p=0.30).
Discussion: The Endocrine Society’s current guidelines for pituitary imaging in evaluation of secondary hypogonadism is based on 2 urological studies. Pituitary imaging is recommended in severe secondary hypogonadism (TT<150ng/dl), panhypopituitarism, hyperprolactinemia, or symptoms or signs of tumor mass effect. The incidence of pituitary adenomas or empty-sella syndrome found in our study was not greater than the prevalence of these in the general population, indicating that there is little value to routinely obtain MRI in the evaluation of men with secondary hypogonadism. Pituitary adenoma and empty-sella syndrome are associated with very low FT and high prolactin levels, respectively. The higher (but not significant) incidence of pituitary abnormalities in men without MetS/T2DM may suggest greater utility of pituitary imaging in this group.
Conclusion: We do not recommend the use of MRI for routine evaluation of all men with secondary hypogonadism. MRI is warranted in men with higher PRL or very low FT, both of which are associated with pituitary structural abnormalities. Further research is needed to define pituitary MRI abnormalities and men without MetS/T2DM.
Objective: In men with secondary hypogonadism, the utility of routinely obtaining a magnetic resonance imaging (MRI) to exclude hypothalamic-pituitary pathology is not well studied. Hypogonadism is strongly associated with the metabolic syndrome (MetS) and type 2 diabetes (T2DM) however the exact mechanism is unknown. We performed a retrospective cohort study to evaluate the yield of pituitary MRI in men with secondary hypogonadism. We also determined if there were endocrinologic or hypothalamic-pituitary differences between men with and without metabolic syndrome (MetS) and/or type 2 diabetes (T2DM)
Methods: We performed retrospective chart review of men who received MRI of the brain during evaluation for hypogonadism. Baseline total testosterone (TT), free testosterone (FT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) were collected. We determined if men had the metabolic syndrome or diagnosis of type 2 diabetes mellitus. Statistical analysis was performed using Mann-Whitney test for continuous variables and Fisher’s exact test for categorical variables
Results: Eighty-eight men were included in the study, 16 (18%) had abnormal MRI. Pituitary adenoma was found in 9 (10%) men, and empty-sella was found in 7 (8%) men. Men with pituitary adenoma had significantly lower FT levels compared to men with normal MRI (18.7 pg/ml vs. 36.4 pg/ml). Men with empty-sella had significantly higher PRL compared to men with normal MRI (21.4 ng/ml vs. 11.2 ng/ml). Most men (80%) had MetS/T2DM. No endocrinologic differences were found between men with and without MetS /T2DM. Men without MetS/T2DM had higher incidence of abnormal MRI than men with MetS/T2DM (28% vs 16%), but this difference was not significant (p=0.30).
Discussion: The Endocrine Society’s current guidelines for pituitary imaging in evaluation of secondary hypogonadism is based on 2 urological studies. Pituitary imaging is recommended in severe secondary hypogonadism (TT<150ng/dl), panhypopituitarism, hyperprolactinemia, or symptoms or signs of tumor mass effect. The incidence of pituitary adenomas or empty-sella syndrome found in our study was not greater than the prevalence of these in the general population, indicating that there is little value to routinely obtain MRI in the evaluation of men with secondary hypogonadism. Pituitary adenoma and empty-sella syndrome are associated with very low FT and high prolactin levels, respectively. The higher (but not significant) incidence of pituitary abnormalities in men without MetS/T2DM may suggest greater utility of pituitary imaging in this group.
Conclusion: We do not recommend the use of MRI for routine evaluation of all men with secondary hypogonadism. MRI is warranted in men with higher PRL or very low FT, both of which are associated with pituitary structural abnormalities. Further research is needed to define pituitary MRI abnormalities and men without MetS/T2DM.
Methods: We performed retrospective chart review of men who received MRI of the brain during evaluation for hypogonadism. Baseline total testosterone (TT), free testosterone (FT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) were collected. We determined if men had the metabolic syndrome or diagnosis of type 2 diabetes mellitus. Statistical analysis was performed using Mann-Whitney test for continuous variables and Fisher’s exact test for categorical variables
Results: Eighty-eight men were included in the study, 16 (18%) had abnormal MRI. Pituitary adenoma was found in 9 (10%) men, and empty-sella was found in 7 (8%) men. Men with pituitary adenoma had significantly lower FT levels compared to men with normal MRI (18.7 pg/ml vs. 36.4 pg/ml). Men with empty-sella had significantly higher PRL compared to men with normal MRI (21.4 ng/ml vs. 11.2 ng/ml). Most men (80%) had MetS/T2DM. No endocrinologic differences were found between men with and without MetS /T2DM. Men without MetS/T2DM had higher incidence of abnormal MRI than men with MetS/T2DM (28% vs 16%), but this difference was not significant (p=0.30).
Discussion: The Endocrine Society’s current guidelines for pituitary imaging in evaluation of secondary hypogonadism is based on 2 urological studies. Pituitary imaging is recommended in severe secondary hypogonadism (TT<150ng/dl), panhypopituitarism, hyperprolactinemia, or symptoms or signs of tumor mass effect. The incidence of pituitary adenomas or empty-sella syndrome found in our study was not greater than the prevalence of these in the general population, indicating that there is little value to routinely obtain MRI in the evaluation of men with secondary hypogonadism. Pituitary adenoma and empty-sella syndrome are associated with very low FT and high prolactin levels, respectively. The higher (but not significant) incidence of pituitary abnormalities in men without MetS/T2DM may suggest greater utility of pituitary imaging in this group.
Conclusion: We do not recommend the use of MRI for routine evaluation of all men with secondary hypogonadism. MRI is warranted in men with higher PRL or very low FT, both of which are associated with pituitary structural abnormalities. Further research is needed to define pituitary MRI abnormalities and men without MetS/T2DM.
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