Abnormally small pituitary

[gerardo60]

Hi,

I am 44 and have been recently diagnosed primary hypogonadism.

Since low testosterone levels were detected, Ive gone under several tests (LH, FSH, Testosterone,prolactin).  The testosterone values were extremely low (5.9 nmol/L) but all the other ones were normal.  By the way, I had a very delayed puberty - started at 18!  

Also,a CT scan of my pituitary was performed.
The results indicated that I have a simetric but abnormally small pituitary gland.

Not sure what that means but, currently I'm only being treated as primary hypogonadism with Testosterone Replacement Therapy.

What can cause an abnormally small pituitary gland and what other tests should be done?

I feel that only the symptoms are being treated as opposed to the root cause.

Any comments/suggestions?

Thanks!

[rumpled]

Did the doc order free testostosterone or bio-available? You should have the latter as it covers all forms.

Primary means the issue is the gland... secondary would mean the issue is the pituitary. With a small pituitary and delayed puberty - I would guess there is more going on elsewhere but you really need to find a pituitary center.

I would try to get into a pituitary center. They can order, I would think, the proper MRI based on the CT showing the smaller pituitary and low T.

[gerardo60]

Thanks rumpled
From what I've read, the creatine is the only number that is low and the LH/FSH are within normal, what makes me think that is a pituitary issue rather that what I've been told: primary hypogonadism.

In any case, I have an appointment in October.
What other hormones tests should I ask for?

My doctor didn't want to ask for an MRI (seems that the waiting period in BC are too long for those) and ordered a CT scan.... Do you think is worth to do one by myself?  Should it be only a pituitary one or a full brain one?

The endo I'm seeing, have called me for an appointment 6 months from now... not sure how this BC/Canada system works... Kind of dissapointed!

Thanks again

[rumpled]

Without ranges, it is hard to tell where you are in the range - every lab differs except, as far as I know TSH. Plus males and females have to be in different levels for androgens (male/female hormones).

Your doctor did not cover all the pituitary hormones and a CT scan is not normally ordered for pituitary. I do all my pituitary testing at 8am fasting - did you?

I would still seek out a pituitary endo - a neuro-endo - at a larger hospital or university.

[gerardo60]

Thank you for your prompt answer, Rumpled.

The following hormones have been tested:

LH  4.4 IU/L
FSH 7.9 IU/L
Prolactin 11 uG/L
CK 57 U/L
T4 Free 15.6 pmol/L
IGF-1 189 ug/L
Creatine 67 umol/L - Abnormal

It was a CT scan.

Thanks again!

[rumpled]

By *all the other ones* - do you know exactly what hormones were tested - and at what time of day? Did you get a copy?

It was a CT or MRI? A CT is, IMHO, not a proper way to look at the pituitary. The proper way is a dynamic MRI scan. CTs in general cannot really pick up much detail on the pituitary. You may really have partial empty sella or something?

You should see a neuro-endo a a pituitary center for a complete work up. Even the delayed puberty can mean issues with almost any hormone - and it can be an overage or underage of something.

You may be hypopit or panhyopituitary (I am panhypopituitary) and need replacement of other hormones - some can be vital for life.