I am a 47 year old man and recently (29Mar2018) had an annual physical exam. I am 6 feet tall and weigh 295 lbs which is put me as clinically obsess and has a lot of risk especially around type 2 diabetes. I have been managing GERD for the past 20 years through medication such a Tagamet, Prilosec, Prevacid and now Nexium. I had a gastric endoscopy (UGI) performed 10 years ago and showed no sign of abnormalities. My blood pressure is has been high averaging 150/100 and the doctor recently put me on Lisinopril 5 mg. Within the last 4 to 5 months I have gained approximately 40 lbs and have no energy or motivation to do anything about it. I mentioned my lack of energy and motivation to the doctor during the annual physical. The doctor order labs including a testosterone level. The CBC results were all within normal reference levels, TSH was normal at 2.610 MIU/L, Lipid panel had high Cholesterol at 207 mg/dL, HD was low at 25 mg/dL, LDL – not able to calculate because high Trig of 468 mg/dL. The Chemistry panel labs were within reference ranges with the exception to the following Glucose high at 107 mg/dL, ALT/SGPT high at 85 unit/L. The Testosterone level was low at 198 ng/dL.
I met with the doctor to discuss my low testosterone level knowing that my main issue was my weight. It seemed to me that the low testosterone was a contributing factor and maybe starting testosterone therapy it would give me the boost to start exercising and eat better. The doctor stated a second testosterone was necessary to validate the low level and that the insurance companies would not also a prescription without a second low testosterone confirmation.
The doctor ordered a second testosterone level along with prolactin and LH. The testosterone was confirmed low with a result of 148 ng/dL. The LH was normal at 3.8 mIU/mL and the prolactin was slightly elevated at 17.3 ng/mL (reference range 4.0 – 15.2). The nurse called and stated that the testosterone was confirmed low however was secondary because the prolactin was slightly elevated. She stated the doctor wants an MRI to check pituitary gland. It seems that my prolactin level is not significantly high and the likely hood of seeing an microadenoma and especially a macroadenoma are unrealistic. I have had no issues with vision; no headaches however had some issues with impotence. Is it possible to be multiple endocrine neoplasia type I (MEN1) since I have been on GERD medicine for past 20 years? I sure hope not. It seems that it could be secondary hypogonadism. I had a vasectomy two years ago and have had no issues except once in the last two months were one of the testes was sensitive to touch which last only for a day.
Any ideas or will I need to wait for MRI?