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Diagnosed with empty sella syndrome. Having symptoms of hypogonadism. Having high prolactin. What does the finding mean?

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Posted on Wed, 21 Aug 2013
Question: Hello,

I have been diagnosed with empty sella syndrome.

I have symptoms of hypogonadism.

My Thyroid is normal.

My Testosterone levels are borderline low for my age and I have undergone a series of test this week to test for hypopituitarism:

24 hour Cortisol Test
Synacten T+1 hr Cortisol Test
24 hour urine Test
2500mg Metipirone and T+8hrs blood sample
T, Free T, FSH, LH, Prolactin, Aldosterone, Estradiol, SHBG, etc

... basically a full 4-day inpatient program.

I don't have all the results but the ones I have so far show that everything is normal except I have high Prolactin (24 ng/ml).

However, I have been taking a multivitamin for the past 3 years that has some active substances in it that can affect various hormone levels (I also took it during my test). The substances that concern me are:

Saw Palmetto Extract (Berry) (Serenoa repens) (min. 45% Fatty Acids)     160 mg     †
Alpha Lipoic Acid     50 mg     †
Grape Seed Extract (Vitis vinifera) (Standardized for Polyphenols)     25 mg     †
Inositol     25 mg     †
CoQ10 (Coenzyme Q10)     15 mg     †
Natural Trans-Resveratrol [from Japanese Knotweed Extract (Polygonum cuspidatum) (Root)]     10 mg

Which tests would these substances affect at those dosages? Would it be such that the results are wrong and I have to retest? I don't mind redoing a blood test (T, Free T, FSH, LH, Prolactin, Aldosterone, Estradiol, SHBG, etc) but I really don't want to repeat the inpatient tests.

Also, would you be inclined to treat a 24 ng/ml Prolactin?

Thank you.
doctor
Answered by Dr. Minal Mohit (2 hours later)
Dear XXXXXXX hi! And thanks for putting up a query at XXXXXXX
Your first line says your diagnosis is "empty sella syndrome". You have not mentioned how did you find out that but I presume it is MRI diagnosis. As per the diagnosis, your all pituitary hormones will be low. to begin with, Growth Hormone, FSH, LH, TSH, ACTH and prolactin. This is the order they follow. As a result, the end organ hormones also slowly start dipping. There will be low T, low T3 & T4, low cortisol. prolactin is the last to go so you are seeing a near normal value of 24ng/ml which does not require intervention. as far as your supplement intake and their affecting the results of your test are concerned , I am not very sure as they are all herbal products.
If you talk of management of your condition, you will need replacement of all the hormones in physiological doses and for dose titration, you must see your doctor.
regards! all the best.

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Minal Mohit (8 hours later)
Hello,

Please find more information about the herbal supplements:

Saw Palmetto:
Inhibition of both forms of 5-alpha-reductase with no reduction in cellular capacity to secrete prostate-specific antigen is indicated.[12][13][14][15] Other proposals for mechanisms of action include interfering with dihydrotestosterone binding to the androgen receptor, relaxing phytoestrogen.[16][17]

Trans-resveratrol:
A Korean study showed that trans-resveratrol supplementation increased testosterone levels in mice in vivo,[100] which has led to its marketing as a bodybuilding supplement. A Spanish study has also shown the antioxidant to increase sperm production in rats.[101]

The others don't seem very potent. How would the effects of those two substances affect the tests I did:

24 hour Cortisol Test
Synacten T+1 hr Cortisol Test
24 hour urine Test
2500mg Metipirone and T+8hrs blood sample
T, Free T, FSH, LH, Prolactin, Aldosterone, Estradiol, SHBG

Can you tell me which ones would be affected and which ones would not?

Thank you for your followup.

doctor
Answered by Dr. Minal Mohit (8 hours later)
Dear XXXXXXX

As far as I am informed, no human studies have been reported, and these substances do not have therapeutic replacement effect in humans. So they should not interfere with test reports.

Thanks!
Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. Minal Mohit

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Practicing since :1998

Answered : 837 Questions

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Diagnosed with empty sella syndrome. Having symptoms of hypogonadism. Having high prolactin. What does the finding mean?

Dear XXXXXXX hi! And thanks for putting up a query at XXXXXXX
Your first line says your diagnosis is "empty sella syndrome". You have not mentioned how did you find out that but I presume it is MRI diagnosis. As per the diagnosis, your all pituitary hormones will be low. to begin with, Growth Hormone, FSH, LH, TSH, ACTH and prolactin. This is the order they follow. As a result, the end organ hormones also slowly start dipping. There will be low T, low T3 & T4, low cortisol. prolactin is the last to go so you are seeing a near normal value of 24ng/ml which does not require intervention. as far as your supplement intake and their affecting the results of your test are concerned , I am not very sure as they are all herbal products.
If you talk of management of your condition, you will need replacement of all the hormones in physiological doses and for dose titration, you must see your doctor.
regards! all the best.