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What causes microadenoma in anterior pituitary?

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Posted on Fri, 8 May 2015
Question: Hi Doctor,
My question to doctor specialist in treating male sex hormone (Andrologist)

Doctor, I am suffering from low testosterone problem from last 6 months. While into Bodybuilding, I was on high dose of testosterone injection & other steroids.

After having Anabolic steroids, it seems like natural testosterone secretion has stopped. Some time ago I was on sildenafil/tadalafil for sexual intercourse but these days medicines don’t work to create erection due to very low total testosterone level (104.5 ng/dl). I thought to take HCG & Clomid. but, I want to take them under doctors guidance/observation.

Now, I am having very healthy life style included good food, weight lifting and Running. But, didn't found improvement in Testosterone level.

I have already discussed this issue here with Psychiatrist, but found that problem is physiological. So, kindly provide suggesion to increase testosterone through medicines.



Kind Regards,
XXXX
doctor
Answered by Dr. Minal Mohit (23 hours later)
Brief Answer:
low testosterone must have a reason.

Detailed Answer:
Dear Mr. XXXX, Hi! you are welcome on HCM platform. Low testosterone level cannot be due to inj sustanon some 3 months back. high dose testosterone, steroids and anabolic steroids do cause endogenous hormone production to stop for a while but that usually is only short lasting and recovers back once exogenous support is withdrawn.
i your case , i would like to have few more reports, viz. LH, FSH, TSH, FT4, Cortisol, GH, Prolactin. all fasting and morning 8 am sample. probably there is a problem at higher level.
if possible do these tests and let me know.
After doing the tests only it is possible to suggest a right medication as simply supplementing won't help. The reason has to be first found and then rectified.
regards!
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Minal Mohit (48 hours later)
Hello Dr. XXXXXXX

Thanks for your response!

As per provided guidelines with fasting at 8AM, I have gone through under all (LH, FSH, TSH, FT4, Cortisol, GH & Prolactin) test.

I have attached one more report having semen analysis (Password is XXXX in capital letters).

I have still not started any medicine other than Vitamins/Zinc & Magnisium. Kindly, Please review attached report.

Waiting for you response.

Regards,
XXXX
doctor
Answered by Dr. Minal Mohit (25 minutes later)
Brief Answer:
all appear within normal range.

Detailed Answer:
Dear XXXX, hi! all reports appear in normal range but acyually they may be suggesting pituitary suppression. we need to look at Pituitary, so we will be requiring MRI brain for pituitary with contrast. it might come normal or may give us the diagnosis. if it does, then we know what we are dealing with. if it is normal, then we will be requiring pituitar stimulation test. you are based at XXXXXXX , you can see some endocrinologist at XXXXXXX or you can get your tests done and let me know.
regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Minal Mohit (3 days later)
Hi Doctor,

Today, I have gone under Brain MRI with contrast at Focus Imaging, Green Park, XXXXXXX After, scanning technician told me Pituitary seems normal without any tumor and reports will be delivered to me in evening. I don’t understand why Growth Hormone is too less in test report <0.05 ng/ml, whereas Pituitary doesn’t show any problem as per blood report it should be upto 3ng/ml.

But, I performed some search on Internet and found that secretion is very Intermittent and it is difficult to diagnose through blood test. As you suggested ‘pituitary/Insulin tolerance test’ can diagnose the actual problem with pituitary if any.

I will attach report ASAP as I received it from imaging center.

Kindly revisit my actual problem again:
•     Lack of Sex drive
•     Low Testosterone

How can I restart natural secretion of Testosterone? Kindly, assist me on the possibility of causing low testosterone.

Can I start with some medication or it is too early to start . PLZ suggest
Thank/Regards,     
XXXX
doctor
Answered by Dr. Minal Mohit (44 hours later)
Brief Answer:
plan insulin tolerance test.

Detailed Answer:
Dear XXXX, if MRI is reportedly normal, then that rules out any gross pathology affecting the pituitary. Now we need to know the functional status of pituitary. you are right GH has intermittent secretion that is why baseline is not very significant and we cannot go on repeating samples to know which time the secretion peaked. so we do stimulation testing. for that you need to see some endocrinologist at XXXXXXX or you can fix up a appointment for XXXXXXX
treatment we will start only after stimulation studies, not before that.
regards!
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Minal Mohit (5 hours later)
Hi, I have provided some attachments. Please review them.
doctor
Answered by Dr. Minal Mohit (16 hours later)
Brief Answer:
diagnosis is pretty clear.

Detailed Answer:
Dear XXXX, i am sorry to read your report. you already have the diagnosis to all your problems. there is a microadenoma in the pituitary which is the cause of all the problems.
you had earlier communicated that MRI is normal. but now it is microadenoma in anterior pituitary.
mr. XXXX, now we do not need stimulation test. rather, pls let me know your marital status and no. of children.
pls start tab cabergoline 0.5 mg once a week at night.
happy to help. we could reach a diagnosis and detect the problem early before it was too late.
regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Minal Mohit

Endocrinologist

Practicing since :1998

Answered : 839 Questions

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What causes microadenoma in anterior pituitary?

Brief Answer: low testosterone must have a reason. Detailed Answer: Dear Mr. XXXX, Hi! you are welcome on HCM platform. Low testosterone level cannot be due to inj sustanon some 3 months back. high dose testosterone, steroids and anabolic steroids do cause endogenous hormone production to stop for a while but that usually is only short lasting and recovers back once exogenous support is withdrawn. i your case , i would like to have few more reports, viz. LH, FSH, TSH, FT4, Cortisol, GH, Prolactin. all fasting and morning 8 am sample. probably there is a problem at higher level. if possible do these tests and let me know. After doing the tests only it is possible to suggest a right medication as simply supplementing won't help. The reason has to be first found and then rectified. regards!