hormonal imbalances

I'm a 20 year old male.  I've been seeing an endocrinologist because of hormonal imbalances.  My thyroid cascade was normal, but my FSH (34) and LH (25) levels were elevated approximately three times normal. The prolactin was also elevated to nearly 40. My growth hormone was <0.1 (is that normal?), cortisol was normal, and insulin-like growth was 344. Interestingly, my testosterone was 'high-normal' at about 850 and bioavailable testosterone was about 180.

I have a small area on my MRI that is suspicious of a microadenoma, but they can't be sure. It's basically hypointense on one part of the gland--and it's not a definitive tumor.

Due to high levels of all hormones, MAIS is suspected. I am somewhat sexually immature at tanner IV. Testicular size is smaller than normal.  I wondering if testosterone treatment will help or if anything will help me finish developing?  I am worried that I will remain underdeveloped.  I am curious if I should ask my endo. to do any hormone stimulation tests?  It seems like to try and find a diganosis, stimulation tests such as HCG or GnRH could be helpful.  Also, should they measure my DHEA, dihydrotestosterone, or HCG levels?  Is it possible I am resistant to FSH, which could be a cause for the smaller testicular size and the elevated levels of FSH?  I know this is a rare case, but I would think that increasing FSH might stimulate spermatogensis or increase testicular volume? Another thought would be a FSH-secreting tumor, but I know these are rare too. thanks.

[Kevin Pho, MD]

With elevation of several of your hormone tests, a pituitary lesion is rightly suspected.  

You may want to consider further testing for other hormone tests produced by the pituitary.  Serum growth hormone levels after an oral glucose load or an elevated IGF-1 concentration, and elevated 24 hour urine cortisol excretion associated with a high-normal or high ACTH concentration are all further tests to determine whether other parts of the pituiatry are affected.  

With a normal testosterone level, it is unlikely that adding more testosterone would help.  

As for further tests, I would consider what was mentioned above.  In terms of imaging tests a PET scan can be considered for further evaluation.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[MarcyMac]

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