Pituitary Magnetic Resonance Imaging in Male Patients with Hypogonadotropic Hypogonadism: A Single Center Experience

Abstract

Introduction Hypogonadotropic hypogonadism is the gonadal insufficiency that develops due to a deficiency in the secretion of gonadotropic hormones for different reasons. This condition leads to important clinical consequences. Pituitary diseases are among the most important causes, and pituitary imaging has an important place for diagnostic purposes. In this study, we analyzed the pituitary magnetic resonance imaging (MRI) results and laboratory findings of male hypogonadotropic hypogonadism patients followed in our clinic for the last five years. Materials and Method We retrospectively analyzed 56 patients with hypogonadotropic hypogonadism who applied to our endocrinology clinic between 2017 and 2021 and whose pituitary MRI results were available in the hospital data processing system. The patients' ages, initial complaints, pituitary MRI findings and hormone levels were evaluated. Statistical analysis of the data was performed using IBM SPSS Version 22.0 program. Results The mean age of the patients was 37.75 ± 10.95. When the complaints of the patients were examined, it was seen that loss of libido was the most common complaint with a rate of 37.5% (n=21). It was observed that 42.9% of the patients (n=24) had normal pituitary MRI. When the patients were divided into subgroups according to their MRI findings and their hormone levels were analyzed, it was seen that the mean total testosterone level was significantly lower in the “Macroadenoma” group than in the “Microadenoma” group (p < 0.05). Conclusion Indications for pituitary imaging in patients with hypogonadotropic hypogonadism are not clear, especially according to laboratory findings, and there is a need for comprehensive multicenter studies on this subject.

Keywords

• hypogonadism
• magnetic resonance
• pituitary gland

Hipogonadotropik Hipogonadizmli Erkek Hastalarda Hipofiz Manyetik Rezonans Görüntüleme: Tek Merkez Deneyimi

Abstract

Giriş Hipogonadotropik hipogonadizm, gonadotropik hormonların farklı nedenlerle salınımındaki eksikliğe bağlı gelişen gonadal yetmezlik tablosudur ve önemli klinik sonuçlara yol açar. En önemli sebepleri arasında hipofizer hastalıklar yer almakta olup hipofize yönelik görüntüleme tanısal amaçlı önemli bir yere sahiptir. Biz bu çalışmada kliniğimizde son beş yılda takip edilen hipogonadotropik hipogonadizm tanılı erkek hastaların hipofiz MR (Manyetik Rezonans) görüntüleme sonuçlarını ve laboratuvar bulgularını inceledik. Materyal ve Metod 2017-2021 yılları arasında endokrinoloji polikliniğimize başvuran ve hipofiz MR görüntüleme sonuçları hastane bilgi işlem sisteminde mevcut olan hipogonadotropik hipogonadizm tanılı 56 hasta retrospektif olarak incelendi. Hastaların yaşları, geliş şikayetleri, hipofiz MR görüntüleme bulguları ve hormon düzeyleri irdelendi. IBM SPSS Versiyon 22.0 programı kullanılarak verilerin istatistiksel analizi yapıldı. Bulgular Hastaların yaş ortalaması 37.75 ± 10.95 olarak saptandı. Hastaların başvuru şikayetleri incelendiğinde en sık libido kaybı %37.5 (n=21) olduğu görüldü. %42.9 hastanın (n=24) hipofiz MR’ının normal saptandığı görüldü. Hastalar MR bulgularına göre alt gruplara ayrılarak hormon değerleri analiz edildiğinde “Makroadenom” grubunda “Mikroadenom” grubuna göre ortalama total testosteron düzeyi anlamlı olarak daha düşük saptandı (p < 0.05). Sonuç Hipogonadotropik hipogonadizm tanılı hastalarda hipofize yönelik görüntüleme yapılmasının özellikle laboratuvar bulgularına göre endikasyonları net olmayıp bu konuda yapılacak geniş kapsamlı çok merkezli çalışmalara ihtiyaç bulunmaktadır.

Keywords

• hipofiz
• hipogonadizm
• manyetik rezonans görüntüleme

References

1. [1] G. Das et al., “Pituitary imaging by MRI and its correlation with biochemical parameters in the evaluation of men with hypogonadotropic hypogonadism,” Endocrine Practice, vol. 25, no. 9, pp. 926–934, Sep. 2019, doi: 10.4158/EP-2018-0609.
2. [2] S. Levy, M. Arguello, M. Macki, and S. D. Rao, “Pituitary Dysfunction Among Men Presenting with Hypogonadism,” Current Urology Reports, vol. 20, no. 11. Current Medicine Group LLC 1, Nov. 01, 2019. doi: 10.1007/s11934-019-0935-z.
3. [3] S. Bhasin et al., “Testosterone Therapy in Men with Hypogonadism: An Endocrine Society,” Journal of Clinical Endocrinology and Metabolism, vol. 103, no. 5. Oxford University Press, pp. 1715–1744, May 01, 2018. doi: 10.1210/jc.2018-00229.
4. [4] E. L. Rhoden, C. Estrada, L. Levine, and A. Morgentaler, “The value of pituitary magnetic resonance imaging in men with hypogonadism,” Journal of Urology, vol. 170, no. 3, pp. 795–798, Sep. 2003, doi: 10.1097/01.ju.0000082960.84075.54.
5. [5] J. T. Citron et al., “PREVALENCE OF HYPOTHALAMIC-PITUITARY IMAGING ABNORMALITIES IN IMPOTENT MEN WITH SECONDARY HYPOGONADISM,” 1996.
6. [6] S. Cipriani et al., “Biochemical predictors of structural hypothalamus–pituitary abnormalities detected by magnetic resonance imaging in men with secondary hypogonadism,” J Endocrinol Invest, vol. 44, no. 12, pp. 2785–2797, Dec. 2021, doi: 10.1007/s40618-021-01586-5.
7. [7] M. Dalvi, B. R. Walker, M. W. J. Strachan, N. N. Zammitt, and F. W. Gibb, “The prevalence of structural pituitary abnormalities by MRI scanning in men presenting with isolated hypogonadotrophic hypogonadism,” Clin Endocrinol (Oxf), vol. 84, no. 6, pp. 858–861, Jun. 2016, doi: 10.1111/cen.13015.
8. [8] D. Hirsch et al., “Pituitary imaging findings in male patients with hypogonadotrophic hypogonadism,” Pituitary, vol. 18, no. 4, pp. 494–499, Sep. 2015, doi: 10.1007/s11102-014-0601-x.

9. [9] L. Ranganath, F. Schaper2, R. Gama3, and L. Morgan2, “Letters to the Editors,” 2001.
10. [10] R. Robinson, “Cost-effectiveness analysis,” Br Med J, vol. 307, no. 6907, pp. 793–795, 1993, doi: 10.1136/bmj.307.6907.793.
11. [11] J. T. King, A. C. Justice, and D. C. Aron, “Management of Incidental Pituitary Microadenomas: A Cost-Effectiveness Analysis*,” 1997. [Online]. Available: https://academic.oup.com/jcem/article/82/11/3625/2865962
12. [12] D. Arpaci et al., “Pituitary Magnetic Resonance Imaging in Patients with Isolated Hypogonadotrophic Hypogonadism: A Single Center Experience,” Medicine Science | International Medical Journal, vol. 4, no. 4, p. 2857, 2015, doi: 10.5455/medscience.2015.04.8312.