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Old 02-21-2009, 10:58 AM   #1
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Low tesrosteron/pituitary adenoma

I am male 37 years old , recently diagnosed low testosterone level and also diagnosed Hypothyroid 3 years back due to elevated Ab TPO (Hashimoto's).
In Dec after so many complain since 3 years finally my last endo agreed to do Hormone test otherwise everyone was blaming thyroid for my all my symptoms.
IN jan Results came back as follows

Total testosterone 309 ( 318-1050)
Prolactin 24 (3-18)
LH 3.5 ( 1.6-18.1)
FSH 1.7 (1.4-9.1)
Free testosterone 59 (52-180)

Cortisol 15.1 (3.1-22.1)
Cortisol 11.1 (this is the one for urine collection)

TSH 1.67 (0.6-4.0)

FT4 1.37 (0.6-1.8)

Due to prolactin high my doctor order MRI to make sure there is nothing wrong in my pituitary which can be responsible for low testosterone level.

The MRI came back with 4x5x6mm pituitary tumor (Microadenoma).

She started bromocriptine 2.5mg/day , after a month test results are below

Total Testosterone level 216 (241-838)
Free testosteron 74.1 (52-180)
LH 4.4 (1.6-18.1)
FSH 2.2 (1.4-9.1)
Prolactin < 0.2 ( 3-18)

So bromo surely dropped my prolactin level , so she stopped the treatment and want to see for another month if it goes back to high or high normal.

My symptoms are

Muscles weakness
Muscles pain/joint pain
Less energy
Can't do physical work even for 20 mins
mood change
low sex drive
weight gain

My questions are

1. Is my prolactin was really or it can be high because of stress ?

2. what treatment should i go for, i want be a father as well ?

3. Can small adenoma in pituitary responsible for all these symptoms?

Anyone share his or her story i really appreciate it.

 
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Old 02-22-2009, 10:12 AM   #2
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Re: Low tesrosteron/pituitary adenoma

This is somewhat out of my league but I will put my 2 cents in anyway and those of you have have had adenoma's please correct me if I'm wrong.

First, do they know for sure the adenoma was secreting prolactin? Not all are. Your prolacting was not extremely high which you tend to see with prolactinomas I thought.

Second, it is very possible the adenoma is causing other pituitary issues like low LH. Your LH is low considering your T levels are so low. If the high prolactin was causing LH to be low by reducing GnRH from the hypothalmus then I would have expected it to be higher on the test when prolactin was not measurable. So what I'm saying is LH may continue to be low due to pressure on the pituitary from the adenoma, not from high prolactin.

If the high prolactin was not from the adenoma then I do not know all the other causes of high prolactin. I know having an orgasm will jump it up for a few hours. Did you happen to have one before the test was done where it was slightly high?

What kind of treatment is tough and is a personal choice. Obviously if you want to have kids though you either have to get LH and FSH up or you will have to be on HCG to keep the testicles stimulated. Your decision at this point seems to be do you have the adenoma removed or not. If not you will likely be on hormone replacement for life and this should include HCG to keep you fertile. Do not believe the doctor that says we will give you HCG when you are ready for kids. Sometimes the atrophy that has occured in the testicles may not be reversable by that point. If you go for the surgery find a university hospital that specializes in pituitary surgery. It is very difficult surgery to get right. There is a website that specializes in pituitary disorders you can look for. They give lists of hospitals too I believe.

Yes I think most if not all your symptoms are most likely from the adenoma and resultiing hormones out of balance. In any event treat the problem you know you have and see if it cures all the symptoms.

Last edited by hayfarmer; 02-22-2009 at 10:13 AM.

 
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Old 02-22-2009, 11:22 AM   #3
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Re: Low tesrosteron/pituitary adenoma

Thanks for your response,
No my adenoma is not removed yet , it was found couple of months ago through MRI, Could that be a reading error by Radiologist ?. Although my neuro-surgeon i went to check the CD and said has some impression but not clear enough to declare adenoma so who is right i am not sure , even 6mm size is considerably not very small , what do you think ?.
My doctor and other folks in different forum thinks , it is non-functioning tumor which will not do good with Bromo/Dostinex , the best option in my age is to remove it after doing some research and make sure first it is what says in report., what do you think?.
I am in SFO , so far i found Dr Sandeep Kumar has done some surgery in pituitary side, any link or board you can forward that has information like how many surgeries doctor has performed and reviews for those kind of surgeons.
In my age , my testosteron should be atleast 500 in the morning , what do you think ?.
No i didn't had sex day before my blood test, so prolactin surely not increased because of that reason.

 
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Old 02-22-2009, 08:15 PM   #4
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Re: Low tesrosteron/pituitary adenoma

I think your T is definitely too low for your age...no question about that....plus it is in the presence of symptoms of low T. On the tumor I suggest a second MRI. I know that some MRI machines have better resolutions than others. Do some research on that, ask your doctor about it, and go to a facility that has the best machine. Adenomas are small and difficult to see so the better the resolution the better chance of proper diagnosis. They are usually done with and without contrasting agent also. If you have any kidney issues be sure the doctor knows...one of the contrasting agents may cause problems for anyone with existing kidney problems. Most insurance would gladly pay for a second opinion before paying for surgery.

Last edited by Mod-S4; 05-30-2010 at 01:25 PM.

 
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Old 02-23-2009, 12:25 AM   #5
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Re: Low tesrosteron/pituitary adenoma

My first MRI was done with both contrast and without contrast and do have CD for it as well. My Neuro-surgeon (Dr Sandeep kuvmar ) is one of the famous in SFO who done many surgeries in pituitary side said it is surely some impression of adenoma but he was not convince that it is prolactinoma as my prolactin level was not high enough to confirm it . According to him prolactin is a stress hormone and can be high because of stress and if prolactin went down with bromo significantly then it is surely not prolactinoma so in my another test prolactin surely went down below even normal range.
So the question is if i have 6mm adenoma then it is non functioning tumor which can or can't grow but not sure. If he was surely discussing surgery option of and new method of doing surgery and suggesting me surgery because i am young and should not take hormone therapy or other hormone replacement for life time . I can see other side as he is surgeon probably wanted to make money.
Do you know if non-functioning tumor has symptoms if it does , what are those could be ?.If that non functioning tumor damage some of my pituitary cells , is it possible to revert it ?. I was reading some in this forum about reverse protocol of Dr Crisler in Michigan use , any news there ?

 
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Old 02-23-2009, 09:46 AM   #6
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Re: Low tesrosteron/pituitary adenoma

Rohit456;

First welcome to our thyroid dysfunctional family. It is always nice to have new male perspective in the female dominant thyroid disorder world.

I am male 37 years old , recently diagnosed low testosterone level and also diagnosed Hypothyroid - 3 years back due to elevated Ab TPO (Hashimoto's).

In Dec after so many complain since 3 years finally my last endo agreed to do Hormone test otherwise everyone was blaming thyroid for my all my symptoms.
IN jan Results came back as follows


I'm a 33 with Hashimoto's, hypothyroidism, hypoadrenalism, PCOS, IR, and hypoglycemia. Before treating my conditions my estrogen and testosterone were high.. I was a female bear that was apt to chew on nails or anything else to cross my path. The reason for many shifts high or low in the sex hormones.. testosterone/estrogen are adrenal production in nature. Why? Because the pituitary relays improper signals to the adrenals and thus its production capabilities are messed up.

Has your MD tested your ACTH and cortisol levels. Prolactin adenomas normally have 100x or more the normal limit of prolactin. Yours smacks more of a metabolic imbalance. This could be due to under treated hypothyroidism or an adrenal imbalance. Your MD is not covering all bases here. When your prolactin came back high a full pituitary and adrenal profile should have been pulled IMO.

Total testosterone 309 ( 318-1050)
Prolactin 24 (3-18)
LH 3.5 ( 1.6-18.1)
FSH 1.7 (1.4-9.1)
Free testosterone 59 (52-180)


Cortisol 15.1 (3.1-22.1) 63% of normal
Cortisol 11.1 (this is the one for urine collection) No range? Are you suboptimal in range. Optimal is 60-80% for premeno or change of life individuals.
This is insufficient testing to rule out pituitary dysfunction. If your ACTH is above normal and your cortisol is only 60% well you could be looking at adrenal fatigue or mild hypoadrenalism. You need ACTH and DHEA testing. How was this blood test drawn? What time of day was it? Were you in a fasting state? These factors will make a BIG difference in the result of the blood serum cortisol levels.

TSH 1.67 (0.6-4.0)
This is higher than I like. I prefer a TSH about 0.6-1 for the females in my family. My son I watch and hope stays near 1. I do not want to have passed this mess to him. Myself given my hypopituitary and hypoadrenal state.. my TSH is lucky to hit 0.4, despite being hypothyroid.

FT4 1.37 (0.6-1.8)
Your Ft4 level is 64.1% of normal.. what is your Ft3 level? If you have and adrenal imbalance it is often detectable earliest in an Ft4 /Ft3 imbalance.


Due to prolactin high my doctor order MRI to make sure there is nothing wrong in my pituitary which can be responsible for low testosterone level. The MRI came back with 4x5x6mm pituitary tumor (Microadenoma). She started bromocriptine 2.5mg/day , after a month test results are below:


Total Testosterone level 216 (241-838)
Free testosteron 74.1 (52-180)
LH 4.4 (1.6-18.1)
FSH 2.2 (1.4-9.1)
Prolactin < 0.2 ( 3-18)

Estrogen dominance can effect males as well. When E is high T is often low unless you are messed up from two angles like me. You need more adrenal and hormonal information here. Estrogen, DHEA, Aldosterone, pregnenolone, progesterone, vit D, B12, ferritin, and ACTH.

How is your blood sugar? Have they tested you for insulin resistance/reactive hypoglycemia (IGF - insulin growth factor and GTT - glucose tolerance test)? This can effect things as well. There is a lot that can be done to get you a clearer picture. Your MDs do not seem to be doing it for you though,

So bromo surely dropped my prolactin level , so she stopped the treatment and want to see for another month if it goes back to high or high normal.

My symptoms are
Muscles weakness - could be an IR/reactive hypoG thing or an adrenal thing.
Muscles pain/joint pain - could be hashimoto's or IR/RHG
Less energy - low/suboptimal adrenal function or mild hypothyroidism...
Can't do physical work even for 20 mins - could be an IR/reactive hypoG thing.
mood change
- estrogen and testosterone big contributers here...
low sex drive - Testosterone and hypoadrenalism will do this...
weight gain - suboptimal T3 levels will do this..

My questions are
1. Is my prolactin was really or it can be high because of stress
? Stress can effect issues. Did you have any leakage or discharge from your nipples? How about serious itching? With prolactin adenomas you normally have milk/fluid produced and leaked from the breast tissue.. yeah in males too. This is due to the HUGE magnitude of prolactin emitted by the adenoma.. however yours wasn't making much excess prolactin, Prolactin 24 (3-18) puts you ar 140% of normal range. Most worry when you are 1000+% of normal. Increased prolactin levels are often seen in people with hypothyroidism. Given your low high level I would suspect that there is something else a foot with the prolactin.

2. what treatment should i go for, i want be a father as well ? A reproductive endocrinologist will be able to discuss fertility options with you and would most likely look at your estrogen AND testosterone and more. They may get to the bottom of your imbalance sooner than your current MD.. but getting a good MD is like finding a plastic needle in a haystack.

3. Can small adenoma in pituitary responsible for all these symptoms?
Symptoms males experience because you do not have the wonderful menstration cycle are headaches or vision problems, caused by the enlarged pituitary pressing against the nearby nerves from the eyes and decreased libido.

Your symptoms are to varied and wide spread for it to be JUST a prolactin adenoma. The headaches and migraines almost always come before the decreased libido males. Are you having migraines? I had migraines and they were the result of increased Cerebral fluid pressure on my brain. My Hashimoto's was actually attacking my Mylan protein in my brain as well. You need to look at everything. Your neuro-surgeon was spot on and he would be the best to interpret the adenoma on the scans. I thin you need a heck of a lot of blood work and you might just be surprised to find it as simple as needing adrenal support and a change in thyroid medication regime.

MG
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Old 02-23-2009, 05:51 PM   #7
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Re: Low tesrosteron/pituitary adenoma

Thanks for your response.
I do have headaches which i can call migrane as well.. Lack of motivation is also another thing i have been dealing with. I called today UCSF to setup an appointment with pituitary department to see if they can suggest me some things.
My Endo did pretty much all the test as far as hormones are concern , Yes my IGF insulin factor is fine in fasting , all my test ran in fasting.
If one has impression of adenoma or tumor in MRI that surely indicate issues with pituitary which can be non-functioning or functioning , what do you think ?.
Do i have to do another MRI to confirm this or contract and w/o contrast one is fine ?. If i do surgery do you think after tumor removed those symptoms can be reversed. ?

Any life style or other things i can do to reverse this or increase my quality of life. Is this pretty common to have these kind of symptoms in 37 years of age.?

 
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Old 02-24-2009, 06:40 AM   #8
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Re: Low tesrosteron/pituitary adenoma

Rohit456;

Thanks for your response. Your welcome.

I do have headaches which I can call migrane as well.
This could be the adenoma or it could be low B12/Mg. My migraines went away when my B12 and Mg deficiencies were addressed and my thyroid supplementation regime initiated.

Lack of motivation is also another thing i have been dealing with. This is an adrenal/hypothyroid symptom. More often linked to hypoT depression.

I called today UCSF to setup an appointment with pituitary department to see if they can suggest me some things. Good. Always get a second opinion, especially when you are in doubt.

My Endo did pretty much all the test as far as hormones are concern , Yes my IGF insulin factor is fine in fasting , all my test ran in fasting. So you have Ft3 results? You have DHEA and ACTH results somewhere? How about the estrogen and aldosterone levels? Ferritin? B12? Mg? Glucose tolerance test? Get copies of EVERYTHING, even your MDs note summaries. They can be illuminating and then you will be able to do your own calculations to determine if you are with in OPTIMAL statistical range versus the statistical AVERAGE normal range computed off of the OPTIMAL range.

If one has impression of adenoma or tumor in MRI that surely indicate issues with pituitary which can be non-functioning or functioning , what do you think ?.
Do i have to do another MRI to confirm this or contract and w/o contrast one is fine ?.
I think that given the neuro-surgeons assessment of your last scan a second scan is warranted to check on the status 6 months after the first. This will allow the minimal window of time to determine if an adenoma is present that it is growing and needs to be removed. Now that the target area is determined a MRI with contrast is not needed. Adenomas light up like a bulb in a normal MRI scan. If you have an adenoma it will be detectable.

If i do surgery do you think after tumor removed those symptoms can be reversed. ? Surgery should eliminate the migraines, if the possible adenoma is the source. Otherwise it will do nothing about those. The removal of prolactin or ACTH producing adenoma will result in the excess Prolactin/ACTH being removed from your body. Will you return to an optimal state afterward? I can not say. There is always a chance that something may go wrong in surgery and the pituitary glands are so small. Surgery and trauma has been known to cause the pituitary to fail. So it is possible that things will improve with surgery, whether this cures it.. No one can say definitely.

Any life style or other things i can do to reverse this or increase my quality of life. Is this pretty common to have these kind of symptoms in 37 years of age?
You are talking to a martial art instructor that was a college athlete (soccer and track) when this junk hit. I got pregnant working on my ChemE. Pregnancy started a chain reaction that has systematically been destroying my endocrine system ever since... Hashimoto's woke up. I tried diet and exercise and supplements to manage he symptoms, but nothing worked. I needed thyroid hormone supplementation to put my antibodies in check and slow down the symptoms, I had to fight to get an MD to consider the Free T results. The MDs appeared to fixate on the TSH. It took 5.5 years to get treatment because of a NORMAL TSH level.

The lack of thyroid support allowed my adrenals to fail in cortisol/aldosteronne synthesis. Existing in a hypothyroid-hypoadrenal state resulted in an elevation of triglycerides, development of PCOS/IR/Reactive hypoglycemia and malabsorption nutrient effects IMO.

The malabsorption effects due to low thyroid hormones resulted in low levels or deficiencies in B12, D, Mg, Ferritin. These aggravated my psuedotumor cerebri and hypothyroid-hypoadrenal symptoms. My neurologist/Ph.D. friend, my neurologist, and my neuro-opthamologist all concurred that the natural treatment of migraines to be applied first is adding 400 mg of magnesium and a SUPER B complex to my dietary regime. B6 and B12 really help with the migraines. B12 is also important in adrenal support and conversion processes. Mg helps with muscle signals and communications. It cuts down on cramps, weakness, and effects the intensity of migraines as well. This type of supplementation should only be performed after determining your own B12 and Mg levels. Low K and deficient vit D caused severe muscle cramps and bone aches. Supplementing the K by dietary adjustment and taking 150% the daily dose of K a day helped with my K deficiency. I have to take 1000-2000% the normal vit D recommended intake a day. This has worked to get me back in balance.

Low ferritin can mimic hypothyroid symptoms to a T. It is a major contributor in hair loss, fatigue, muscle weakness, and can effect thyroid hormone transport and conversion. Ferritin id the oxygen iron storage capacity. You can have NORMAL iron but a ferritin level that is not in the 50-80% of normal range resulting in your muscles starving with activity. Supplementation of just 40 mg of ferrous fumarate when your ferritin is suboptimal can be enough to stop hair issues and give renewed life to your muscles.

So from my experience you need to look at a few things before you go into pituitary tumor scare mode. I think you should get another opinion on the current MRI results that you have. I think you should get some blood work drawn for completeness. Ferritin, B12, Mg, Ft3 at minimum. Do your headaches come before or after eating? Maybe 1-2 hours after eating? An IGF level less than 1 normally rules our insulin resistance. Fasting glucose and insulin levels can not detect reactive hypoglycemia if you have hypoglycemic symptoms go and get the GGT run as well. When in doubt get it checked out. It is the diagnostic rule I live by.


MG
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Last edited by mkgbrook; 02-24-2009 at 06:42 AM.

 
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Old 02-24-2009, 11:08 PM   #9
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Re: Low tesrosteron/pituitary adenoma

Yes i did perform other test as well ,
FT3 =3.3 (2.6-4.2)
Vitamin D = 37 (32-100 ) , It found low last year at 17 so i have been taking 4000IU since 6 months.
B12 = was low in 2006 (276) (300-1000). I took some oral and muscular injection and that brought up to 7000 which is way high, My doctor also tested Ab for pernicious anemia to make sure it is not positive which is use to absorb b12 (Intrinsic factor ) , i am taking B Complex which include B6 and B12 (Methylcolbium). So B12 is way above way above normal now.

Ferritin test was done last year and it came back mid above normal , don't remember result.

Cortisol test is done for both Urine and in Blood and both came back above normal range
In Blood it was 15.1 ( 9-22)
Urine one 12 (8-16 at 8:00)

I believe Cortisol test is use for ACTH, correct . Insulin resistance test also done in the morning at fasting and that came back 98 which is also normal.
My doctor also perform other AB test which include for Lupus, Mysthernia Gravis and some more i don't remember , i remember those as ones used for muscles weakness part.

I also hands fall sleep , which read can be because of Pituitary disorder condition , what do you think ?.
I thought when prolactin was elevated , this is it and Dostinex and Bromo wil take care of it but my Neuro and other people in this forum said my prolactin is not very much elevated so it should not be prolactinoma so must be non functioning benign tumor which either already damage the pituitary cell which may be some LH/FSH and GH , that damage may not revert but can be revert if surgery is perform , what do you think?.
Do you know if we have other option of treatment rather taking TRT which damage my own testicles to produce testosterone and make me permanent infertile?.
I really appreciate your responses.I got appointment from UCSF neurological head expert in pituitary condition as per google, hope things will work out soon and i will be back in my normal life and enjoy life rather hate it.

 
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Old 02-25-2009, 06:28 AM   #10
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Re: Low tesrosteron/pituitary adenoma

Rohit456;

Yes i did perform other test as well ,
Okay this helps me look at your thyroid balance better. Given your Ft4 level was 64.1% +/- 2.5-5% depending on analysis method..

FT3 =3.3 (2.6-4.2) You are 43.75% of normal range here. Something is suppressing your T3 generation and making you low in T3 in comparison to your T4 levels. Being suboptimal in T3 will generate a lot of physical hypoT symptoms. You need to test your conversion issues. Your cortisol is not high.. so this isn't the result of hyperadrenal cortisol conversion suppression. You need to look at your reverse T3 production and thyroglobulin binding capabilities. I bet your RT3 is high and you need a touch of T3 added to your thyroid supplement regime. Two out of three thyroid patients need a bit of T4. This explains why your TSH is just out of optimal range and pushing 2.

Vitamin D = 37 (32-100 ) , It found low last year at 17 so i have been taking 4000IU since 6 months.
UGH! This is still low. You are 7.4% of normal range. You need more. My MD isn't happy until I am 40-60% of range. I have chronic bone aches if I fall and linger below 40%.

B12 = was low in 2006 (276) (300-1000). I took some oral and muscular injection and that brought up to 7000 which is way high, My doctor also tested Ab for pernicious anemia to make sure it is not positive which is use to absorb b12 (Intrinsic factor ) Good deal. One question. How long after the injections did they wait to retest your levels. Injections have a way of boosting levels for 4-6 weeks and then you crash again.

i am taking B Complex which include B6 and B12 (Methylcolbium). So B12 is way above way above normal now. GOOD and GOOD. Be sure you are still in normal/optimal range. If it has been a while just get a recheck. This will allow you to see how well you are processing the oral B supplementation.

Ferritin test was done last year and it came back mid above normal , don't remember result. Okay. This is good, but since it has been a year you should retest. My MD tests quarterly. She will fall back to six month level checks when I have been optimal in range for a year. Right now I am just a roller coaster of endocrine function she prefers to keep close tabs on me.

Cortisol test is done for both Urine and in Blood and both came back above normal range
In Blood it was 15.1 ( 9-22) 46.9% My MD likes me between 60-80%. This is just a bit low given the error in this test.
Urine one 12 (8-16 at 8:00) This is 50%.. also a tad low given the time of day. You may have some adrenal fatigue going on.. but that is HARD to diagnose.
These are okay. The only other thing you could do is teest for adrenal fatigue using a saliva cortisol rhythm test.. HOWEVER given your T3 levels are low in comparison to your T4 levels.. I think your cortisol function is fine.

ACTH is another pituitary hormone. If it is mildly high like your prolactin and your adrenal outputs are just in optimal range. ACTH is the pituitaries call to the adrenals to make more cortisol. You shouldn't have the cortisol with out the ACTH... it is like running Ft4 and Ft3 without running a TSH. There are two main types of pituitary tumors: prolactin and ACTH. If your tumor is producing ACTH in EXCESSIVE amounts then an ACTH will show it. If given EXCESS ACTH your only producing cortisol in 50% or lower levels.. well then you have a clear case of adrenal fatigue or mild hypoadrenalism.

It is good that you have had a thorough antibody study and IR has been looked into.

I also hands fall sleep , which read can be because of Pituitary disorder condition , what do you think ?. I have Hashimoto's encephalopathy and a resultant neuropathy. My hands and feet give me all sorts of strange signals. My pituitary gland is just sluggish... except in ACTH. Given my adrenal collapse it LOVES to put out ACTH. Tell the neurologist about the hands. Have you been tested for metacarpel(sp) syndrome? Have you had a lumbar puncture to test CSF pressure and contents? It is an interesting experience. I had one last year and my neuro came out with the "Doodle, you are right again!" Learning to listen to my body and symptoms has been the best thing to come out of my walk on the polyglandular endocrine syndrome carnival ride.

I thought when prolactin was elevated , this is it and Dostinex and Bromo wil take care of it but my Neuro and other people in this forum said my prolactin is not very much elevated so it should not be prolactinoma so must be non functioning benign tumor which either already damage the pituitary cell which may be some LH/FSH and GH , that damage may not revert but can be revert if surgery is perform , what do you think?. I think that something is up with your pituitary gland. The levels of your prolactin are too low for it to be a hormone producing tumor according to most studies. It may be pressing and stimulating an excess of prolactin, but it isn't a dedicated prolactin factory. I also think that you want to follow up this with more testing. You need the ACTH run. It won't hurt to test your past deficient vitamin levels at the same time. I also think that your Ft3 levels are lower than they should be if your thyroid function and conversion was optimal. SO I think you need RT3, TBG testing there.

Do you know if we have other option of treatment rather taking TRT which damage my own testicles to produce testosterone and make me permanent infertile?. Get your DHEA levels tested. If these are low/suboptimal supplement by taking DHEA. DHEA is the precursor to testosterone and estrogen. Your adrenals should see it, grab it and change it into testosterone as needed. This will be milder that TRT. Talk with your MD about DHEA supplementation. You do not want to exceed 20-25 mg a day. You can tell when you have too much, because you get acne and become a walking oils slick. You will see an increase in acne and oil output initially, but it should stabilize with in 1-2 weeks.

I really appreciate your responses.I got appointment from UCSF neurological head expert in pituitary condition as per google, hope things will work out soon and i will be back in my normal life and enjoy life rather hate it. Good luck and keep us posted. You can teach people a lot through your experiences with this matter.

MG
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Old 02-25-2009, 02:33 PM   #11
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Re: Low tesrosteron/pituitary adenoma

[Today i went for lab test and did pretty much everything what you asked for to rule GH/FSH/LH/ACTH/Cortisol/Vitam D/Mag/B12/IGF-1/Insulin one /Metabolic/TSH/FT4/FT3 /Testosteron complete/DHES+/Prolactin.
They took 14 test tubes :-), hope these test should be enough for UCSF endo-neuroslogist to give me positive answer and start my treatment path.

 
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Old 02-27-2009, 10:36 AM   #12
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Re: Low tesrosteron/pituitary adenoma

Here is the some of the test result which i did on Wednesday.The test done in fasting.

Glucose Serum 93 (65-99)
Potassium serum 4.2 (3.5-5.2)
Sodium serum 137 (135-145)
Calcium serum 9.8 (6.5-10.6)
Alkaline Phosphate 95 (25-150)

Hemoglobin Aic 5.5 (4.8-5.9)
LH 2.4 ( 1.5-9.3)
Testosterone Serum 211 (241-827)
FSH 1.7 (1.4-18.1)

Estrodil 39 (0-53)

Ferritin Serum 61 (22-322)
Vitamin B12 394 (211-911)
Magnessium 2.0 (1.6-2.6)
ACTH Plasma 24 (6-48)
Cortisol AM 11.8 (4.3-22.4)

FT3 3.4 (2.3-4.2)
FT4 1.53 (0.61-1.76)
TSH 1.230 (0.45-4.5)

I still have some Pituitary results pending which include GH and prolactin and free testosterone levels.

Some more result came back
Here are some more results came to me still some free testosterone and IGF binding is pending.

DHEA 337 (160-800)

Prolactin serum 11 (3-18) , keep in mind i am not taking Bromocriptine 2.5mg/day .. So shouldn't it not increase that much in just month not taking bromo, Normally i see in people in different forum is around 4-8 w/o bromo.

GH (ICMA ) <0.05 (0-6)
GH binding is pending.

I am not sure what will be the optimum value here , is this really suppressed.

Your input is really appreciate it.



Can you provide your input about my results and if you can come up with list of question i should be asking to Neuro surgeon on Monday i really appreciate it.

Thanks

Last edited by Rohit456; 02-28-2009 at 11:35 AM.

 
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Old 02-28-2009, 09:49 PM   #13
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Re: Low tesrosteron/pituitary adenoma

Rohit456;

Here is the some of the test result which i did on Wednesday.The test done in fasting.


Glucose Serum 93 (65-99)
Potassium serum 4.2 (3.5-5.2)
Sodium serum 137 (135-145)
Calcium serum 9.8 (6.5-10.6)
Alkaline Phosphate 95 (25-150)
This is your basic metabolic profile and it looks good. If your adrenals were severely off mark the K value would not be where it is... your Sodium is a tad low. Is your Chloride low too? Or is your CO2 high?

Hemoglobin Aic 5.5 (4.8-5.9) Another good result here.

LH 2.4 ( 1.5-9.3) This is on the low side which points to suboptimal pituitary performance. Your FSH is comparatively low with respect to your LH.. it is another indicator of suboptimal pituitary function.

Testosterone Serum 211 (241-827) This is LOW it will be interea=sting to see what the DHEA shows.

Estrodil 39 (0-53) Umm this looks high for a male. I would think that your estrogen would be lower. This may be a sign that your DHEA and progesterone levels are too low. I will be interested in hearing what your MD says about it. They may say it is normal in range.. but is this range used for women and men. Men have a different optimal than women.

Ferritin Serum 61 (22-322) 13% of normal
Vitamin B12 394 (211-911) 26.1% of normal here
Magnessium 2.0 (1.6-2.6) You are 40% here
BINGO! You have some metabolic absorption issues going on here. your ferritin and B12 levels are low. You want your ferritin, B12, Magnesium levels at least 40% in range if my MDs are anything to go by. Magnesium is the normally the last to fall. You would benefit from supplementing B12 and Ferrous fumarate if your MD thinks it is safe. Always check with the MD.. some don't believe in giving men any iron supplementation...

ACTH Plasma 24 (6-48)
Okay this is good it is normal in range. This indicates that your adenoma is not producing ACTH.. which is more common than a prolactin producing adenoma.

Cortisol AM 11.8 (4.3-22.4) This is 41% of normal. If this is your 8 am fasting result.. this can be taken as an indicator of fatigue. An ACTH stimulation test may be warranted.

FT3 3.4 (2.3-4.2) This is 57.9% It is in the optimal 50-80% window.. but let us see if you are balanced.
FT4 1.53 (0.61-1.76) You are 80% of normal here. Your ft3 level is low in comparison to your Ft4 level. Given your low0mid range cortisol the reason for this is most likely high conversion of T4 ot RT3. You need an RT3 test confirmation to be sure.

TSH 1.230 (0.45-4.5) Near optimal. However each person is different. Mine sits at 0.4.. but I am far from hyperT.

Some more result came back
Here are some more results came to me still some free testosterone and IGF binding is pending.

DHEA 337 (160-800)
I was wanting this one! This is low. My MD wants me in the 60-80% range. But I am female.. male levels may differ. However I would think that 50% would be a good average. You are at 37.6% of normal. Boosting your DHEA by 10 mg in the morning may help your testosterone. Once again check with your MD.. this is a non-prescription supplement.

Prolactin serum 11 (3-18) , keep in mind i am not taking Bromocriptine 2.5mg/day .. So shouldn't it not increase that much in just month not taking bromo, Normally i see in people in different forum is around 4-8 w/o bromo.
The MD is going to argue normal in range. I have had prolactin levels that high and my MDs don't flinch. Until you fall right on the range limit or over many do not see it as an issue. Getting optimal treatment and proactive care is a challenge to say the least.

GH (ICMA ) <0.05 (0-6)
GH binding is pending.
I am not as familiar with this eather, but it is very low. The GH binding will be necessary to determine if it is a binding tie up issue or overall low production of GH here.

I would ask for an ACTH stim test to with a complete adrenal profile to see how your adrenals respond to ACTH stimulation. Also ask if you can safely add DHEA, iron, B12 supplementation to your regime. Also ask about getting tested for RT3 levels. Humm.. given that your prolactin is still in normal limits after a month and no other pituitary hormone appears to be running wild your adenoma.. if present appears to be inactive. I would ask your MD if he would recommend a send MRI/Ct to confirm/refute the first questionable micro-adenoma.

Listen to what the MD has to say and stress your concerns over the low testosterone and suboptimal B12 and Ferritin. Pity you don't have a vit D level. That may just be in the tank too. Good luck at your appointment. Keep us posted.

MG
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Old 02-28-2009, 10:30 PM   #14
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Re: Low tesrosteron/pituitary adenoma

i just want to add my blood was taken at 10:10am instead of 8:00am , I went to lab at 8:45am and had to wait for like an hour or so to get my number , Can this be an issue with some results number are low or low normal . I am waiting for some more results like Vitamin D and Free testosterone , Bio available .
One thing that i saw in this result is Prolactin which is 11 in just 28 days of w/o bromo from <0.2 that make me think if i don't take bromo for another month it will be above 18 for sure which surely confirm prolactinoma, what do you think ?.
Can you come up with some list of question i should be asking at UCSF pituitary department as i will be driving for 2 hours to get there and want to make sure i don't miss anything in my appointment.

My chloride serum is 99 (97-108)
CO2 28 ( 20-32)

Does dry eyes be low testosterone symptoms?.
Have you heard any success using Velvet bean to reduce prolactin level , there are lot of things on internet
Thanks for your continue help.

Last edited by Rohit456; 02-28-2009 at 11:33 PM.

 
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Old 03-02-2009, 05:42 AM   #15
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Re: Low tesrosteron/pituitary adenoma

Alright your low Cl corresponds to the low normal sodium level. Are you on a low salt diet?

CO2 is fine. No sign of acidosis there.

Taking the blood for cortisol at 10:10 am will result in a lower level than expected. If the blood wasn't frozen and handled properly the result will be biased as well. The saliva test is better all round because you self-administer it and keep it refrigerated and as a result can take it at 8 am, 12 pm, 5pm, and 12 am. This allows you to see how your cortisol is flowing through out the day.

Prolactinomas produce HIGH levels of prolactin when active. Women have a higher level of prolactin corresponding to a higher estrogen level... and lower testosterone level. Your prolactin may continue to rise, but even at 18 it hardly exceeds the excessive prolactin level standard for women of at or above 600 mIU/I. Females have a range of 30-600.

In men hyperprolactinemia is normally when you have more than 15 ng/mL of prolactin in your bloodstream at a given time. One cause/symptom.. they are not sure which comes first is hypogonadism in which you do not produce enough testosterone. So you really need to address the testosterone issue.

As to the questionable pituitary adenoma, I think you should request a rescan at the neurosurgeon's request. The low testosterone does fit with a pit adenoma that is producing prolactin, BUT the levels of prolactin are not as expected with that diagnosis.

Dry eyes is a symptom of low thyroid hormone.. especially suboptimal T3 levels.

You need your RT3 levels tested. Optimizing your thyroid hormone levels may help with the pituitary and adrenal function as well.

Ask about your estrogen, testosterone ratio. Ask what can be done to elevate your testosterone with out compromising your fertility... this will probably get you a referral to a reproductive endocrinologist. Ask about whether supplementation of ferritin with 27-30 mg of ferrous fumarate is okay. Ask if you can boost your B12 with a super B complex. Ask if you can add 10-20 mg of DHEA to your supplement regime. (My MD has her patients START with 10 and move up in 5 mg increments to 20 mg if symptoms do not abate AND you do not show the acne and greasy hair of too much DHEA after 2 weeks on a given dosage has passed.)

I haven't heard anything about velvet bean. That is all I can come up with now. Good luck.

MG
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