The prevalence of structural pituitary abnormalities by MRI scanning in men presenting with isolated hypogonadotrophic hypogonadism.

Abstract

OBJECTIVE:

Hypogonadotrophic hypogonadism (HH) is commonly associated with ageing, obesity and type 2 diabetes. The indications for pituitary imaging are controversial, and current guidelines are based on small case series.

DESIGN:

Retrospective case series from a secondary/tertiary endocrinology referral centre.

PATIENTS:

All men presenting to the Edinburgh Centre for Endocrinology and Diabetes with hypogonadotrophic hypogonadism (testosterone <10 nmol/l and normal prolactin) from 2006 to 2013, in whom pituitary MRI was performed (n = 281). All HH patients referred in 2011 (n = 86) were reviewed to assess differences between those selected for pituitary MRI and those who were not scanned.

RESULTS:

Pituitary MRI was normal in 235 men (83·6%), with 24 microadenomas (8·5%), 5 macroadenomas (1·8%) and 1 craniopharyngioma (0·4%) identified. The remaining 16 (5·7%) comprised a range of minor pituitary abnormalities including small cysts and empty sella. All men with abnormal imaging studies had otherwise normal pituitary function. Imaging abnormalities were associated with a significantly lower age at presentation (50 vs 54 years, P = 0·02), but no differences in testosterone or gonadotrophin levels were observed. Current Endocrine Society guidelines would have prompted imaging in only three of six patients with significant pituitary pathology.

CONCLUSIONS:

Structural pituitary disease is more common in isolated HH than in the general population, and current guidelines do not accurately identify 'at-risk' individuals. Full anterior pituitary function testing has a low yield in patients presenting with hypogonadism. The optimal strategy for determining the need for pituitary imaging remains uncertain.

• Authors: Mazhar Dalvi, Brian R Walker, Mark W J Strachan, Nicola N Zammitt, Fraser W Gibb
• Journal: Clinical endocrinology (Clin Endocrinol (Oxf)) Vol. 84 Issue 6 Pg. 858-61 (06 2016) ISSN: 1365-2265 [Electronic] England
• PMID: 26733239 (Publication Type: Journal Article)
• Copyright: © 2016 John Wiley & Sons Ltd.

Topics

• Adenoma (diagnostic imaging)
• Adult
• Craniopharyngioma (diagnostic imaging)
• Humans
• Hypogonadism (diagnostic imaging)
• Magnetic Resonance Imaging (statistics & numerical data)
• Male
• Middle Aged
• Pituitary Gland (abnormalities, diagnostic imaging)
• Practice Guidelines as Topic
• Prevalence
• Retrospective Studies
• Tertiary Care Centers