Introduction: The current Endocrine Society guidelines (2010) recommend biochemical and radiological evaluation of men with HH to ascertain underlying hypothalamic and/or pituitary aetiology although the cost-effectiveness of this strategy is yet to be established. We did a retrospective audit to ascertain epidemiology, management and diagnostic outcomes for men with HH in our hospital practice against the current Endocrine society guidelines.
Methods: A total of 126 men with biochemistry consistent with HH were identified for the audit period from 20132015. Retrospective evaluation of these patients was done using a local electronic database (Myrddin) to retrieve relevant clinical information.
Results: The commonest symptoms in men with HH included erectile dysfunction (56%), reduced libido (23%), lethargy (15%) and excessive sweating (<10%). A significant proportion of men (36%) with HH were overweight (BMI>30) and/or had diabetes mellitus (25%). Biochemical abnormalities including a raised prolactin, secondary hypothyroidism and abnormal IGF1 levels were noticed in 15%, 15.8% and 4.8% patients respectively. Pituitary imaging was carried out in 67 out of the total 126 patients (53.1%). Radiological abnormalities including macroadenoma (n=10), microadenoma (n=1), empty sella (n=5), and non-specific cyst (n=1) were identified in 25.4% of the scans. Although, none of the men with a BMI>30 (along with no clinical/biochemical features of pituitary dysfunction) had any pituitary tumor detected on radiology.
Discussion/Conclusion: There has been an increase in number of referrals to endocrine centres for men with secondary hypogonadism related to global pandemic of obesity and diabetes mellitus. The majority of men with increased BMI (without clinical/biochemical features of anterior pituitary dysfunction) do not routinely warrant further radiological investigations. This is especially important in context of higher statistical probability of detecting an incidental pituitary lesion (adenoma or empty sella) leading to an increased health-economic burden. There is a need for larger multi-centric studies to reassess BMI related cut offs for further evaluation of men with HH.