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Low testosterone, growth hormone deficiency, MRI showed empty sella pituitary gland. Treatment for enlarged prostate?

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Endocrinologist
Practicing since : 2001
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Background:- An MRI has shown my pituitry gland as empty sella and my testosterone was very low and I have severe injections since March 2010 and daily GROWTH HORMONE injections for 6 months. In oct 2009 and feb 2010 my PSA was OK at 1.5 ng/ml and then XXXXXXX to 3.6 in XXXXXXX 2011 & 4.0 in Oct 2011 (normal range should be <3.5).
I have just had a Prostrate Ultrasound report which says
"increased size at the expense of the middle lobe with calcifications inside, 43 x 45 x 47 mm with a volume of about 45 cc which corresponds to a grade 2 prostatic hypertrophy" My home is UK and Andorra.
My IGF1 was normal before I started on Growth Hormone. after 3 months on GH at .02mg /day my IGF1 XXXXXXX to 39 nmol/L(normal 10 to 29) which improved my symptoms of chronic fatigue. Then I was told to reduce my dosage to 0.1mg/day, so after 2 months my Igf1 reduced to 29.I, coming within normal range,but mys fatigue increased. Then I increased dosage to 0.3mg and stopped drinking regularly and dieted , so then after 4 weeks my igf1 was above normal at 265ng/mL( normal 55 to 238 ng/mL) and my fatigue symptoms greatly improved.
my questions are
1) What is the likely treatment, the consequences and the end result for my enlarged prostrate ?
2) Can you refer me to anything that shows Growth Hormone dosage can be decided by symptom improvements rather than limiting it to within the normal range of IGF1, which is supposedly unreliable,and how quickly does IGF1 respond to a change in G H dosage ?
Posted Sun, 15 Apr 2012 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. V. Kumaravel 7 hours later
Hello,

I do understand that you are on GH (Growth hormone) and testosterone replacement for probable hypopituitrism with empty sella syndrome.

Question: What is the likely treatment, the consequences and the end result for my enlarged prostrate?

The major concern about giving testosterone replacement is the chance of prostatic malignancy. Testosterone can act in your prostate to make it grow. That is why your PSA (Prostatic specific antigen) levels are monitored. If your PSA levels are increasing, it is preferable to have a prostate biopsy, to see the nature of growth.

Question: Can you refer me to anything that shows Growth Hormone dosage can be decided by symptom improvements rather than limiting it to within the normal range of IGF1, which is supposedly unreliable,and how quickly does IGF1 respond to a change in G H dosage ?

I would like to know your age and also wanted to know whether you have any other medical problem as these can influence your level of fatigue. Many a times when you have 2 pituitary hormone deficiencies as in your case with testosterone and growth hormone (GH), it is worthwhile to check your cortisol and thyroid hormone levels also. Unless you correct these hormonal problems your symptoms may not completely resolve.

GH dosing regimens should be individualized rather than weight-based. For patients aged 30–60 yr, a starting dose of 300mcg/d usually will not be associated with side effects. Daily dosing should be increased by 100–200 mcg every 1 to 2 months, the goals being an appropriate clinical response, an avoidance of side effects, and an IGF-I level in the age-adjusted reference range.

IGF-1evels might normalize within a week, but, clinical benefits may not become apparent for 6 or more months of treatment.

Older (>60 yr) patients should be started on lower doses (100–200 mcg/d) and increased more slowly.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Low testosterone, growth hormone deficiency, MRI showed empty sella pituitary gland. Treatment for enlarged prostate? 40 hours later
I am 59, 5 ft 9in and was 195 pounds a year ago, dieted down to 175 pounds now with regular excercise, and there are no other meds. In the last 6 months I have felt increased need to empty my bladder when there has not been much urine there. I can email scan of my many blood results if helpful to you, but need email address
Thyroid is OK. cortisol is ok, but dont understand why its way above normal during day ( 8am=6.15ng/ML (normal 3 to 9), 12noon=6.17(NORM 1.5 TO 3), 4pm=5.08(NORM 1 TO 3), 8pm=4.38(NORM 0.8 TO 1.2, midnight=3.52(NORM 0.8 TO 1.2ng/mL) ????
I still have great difficulty in concentrating after 6 months on GH . Have had to sleep most afternoons UNTIL I increased GH dosage to 0.3mg /day, but that takes my IGF1 well above age adjusted norms !! MY LIFE WILL BECOME LIKE A VEGETABLE AGAIN IF I HAVE TO REDUCE GH DOSAGE TO BACK DOWN TO 0.1MG/DAY TO KEEP WITHIN IGF1 NORMS FOR MY AGE.
Is there an alternative to Nebido that wont cause problems with enlarging prostrate, and will GH effect prostrate problem and mean I have to stop that. Is prostrate biopsy a painful and/or difficult procedure? I am told that my PSA is within range for my age, but the ultrasound scan suggests a problem, what does it mean if either biopsy positive or negative for prostrate cancer?

Please also answer my original question.....
"Can you refer me to anything (so I can show my doctor) that shows Growth Hormone dosage can be decided by symptom improvements rather than limiting it to within the normal range of IGF1, which is supposedly unreliable"

 
 
Answered by Dr. V. Kumaravel 6 hours later
Hello,

The Endocrine society’s clinical guidelines help to lay the standards for Adults with GH (Growth Hormone) deficiency. The article by XXXXXXX E. Molitch, XXXXXXX R. Clemmons, XXXXXXX Malozowski, XXXXXXX R. Merriam, and XXXXXXX XXXXXXX XXXXXXX first published in Journal of Clinical Endocrinology & Metabolism, 96(6):1587–1609 can be quoted. But you have to remember guidelines are only guiding us and they cannot be blindly followed. A careful clinical evaluation along with the necessary investigation and the treating doctor’s decision will be the final word.

Your cortisol is at higher side; probably stress and anxiety can also increase your cortisol levels.

Nebido is a testosterone preparation and all testosterone will have an effect in your prostate. GH also can slightly increase your prostate size, but it’s not a major concern as testosterone. If your prostate continues to grow, then testosterone has to be stopped. Prostate biopsy can be done under ultrasound guidance and is not a very difficult procedure. There will be some pain, but tolerable. Depending on the biopsy report you can discuss with your urologist for further treatment.

You can also discuss your tiredness with your treating physician and he may help to decide whether it related to your GH deficiency or anything else.

Hope I answered all your questions. Please accept my answer in case you do not have further queries. Wish you Good Health.

Regards,

Above answer was peer-reviewed by
 
Follow-up: Low testosterone, growth hormone deficiency, MRI showed empty sella pituitary gland. Treatment for enlarged prostate? 38 hours later
PLEASE REFER ME TO A UOROLOGIST, which is what i requested to start with!!!! as I needed advice on my prostrate
thank you for trying to help, but you have not answered my primary concerns about the significance of my scan results. I saw a spanish urologist in andora today BUT HE SPOKE NO ENGLISH , he just perscribed "omnic OCAS 0.4mg per night. but I did not understand what he said.
 
 
Answered by Dr. V. Kumaravel 33 hours later
Hello,

I do understand your concern.

Your prostate ultrasound is suggestive of grade 2 hypertrophy and your PSA (Prostatic Specific Antigen) is elevated to 3.6. The only concern here is to rule out prostatic cancer. That is the reason you are advised to have a biopsy done.

If your biopsy is negative for cancer you will require some medical treatment to decrease the prostate size. If biopsy is suggestive of cancer, then you would require surgery to remove your prostate and some medicines also. Whatever it may be, prostate problems are easily treatable.

The opinion from an Urologist would also be on similar lines. However, if you need to confirm and get specific opinion from an Urologist, please post your query specifically to the concerned specialist and also select the specialty as urology or urinary and bladder problems.

Hope I answered all your questions. Please accept my answer in case you do not have further queries. Wish you Good Health.

Regards,
Above answer was peer-reviewed by
 
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