Hi Just to clarify the prolactin I agree is in the normal range for some instruments and I would investigate further
However the definitely raised FSH and LH suggest a pituitary problem in the first case and if the epilepsy medication changes dopamine secretion it will alter the secretion by the pituitary
The second case looks like a testosterone use with everything bar testosterone low but the symptoms also fit with prolactin Male problems. This is always hard to define as the symptoms are vague not as clear as in the female
Cheers
Paul
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Paul Williams
Sent: Wednesday, 16 April 2014 9:19 AM
To: [log in to unmask]
Subject: Re: Interpretation of male gonadotrophins with normal testosterone
Hi Fiona
A prolactinoma looks to be the cause
Have you done a macroprolactin to see if the elevation is high molecular weight ?
Any other pituitary investigations for micro or macro prolactin secreting tumours ?
Any effects on the visual from the pituitary enlargement ?
Cheers
Paul
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Fiona Davidson
Sent: Wednesday, 16 April 2014 2:32 AM
To: [log in to unmask]
Subject: Interpretation of male gonadotrophins with normal testosterone
Dear all,
We have recently had a coupleof slightly odd male LH and FSH results in the context of erectile dysfunction with normal total testosterone. I was wonder if the collective brain could share their thoughts on how to interpret gonadotrophin results in the absence of obvious primary or secondary hypogonadism?
Patient 1:
44 y/o presenting with erectile dysfunction and prev history of epilepsy (not clear what, if any current medication he is on).
Total Testosterone = 22.7 nmol/L
FSH = 31 IU/L
LH = 28 IU/L
Prolactin = 135 mU/L
UE, LFTs, Lipids all normal. Above results were confirmed on repeat.
Could this be due to anti-epileptic medication?
Patient 2:
27 y/o presenting with low libido and erectile dysfunction and concerned RE fertility. Not on any medication or supplements.
Total Testosterone = 15.3
FSH = < 1
LH = 3
Prolactin = 239
Oestradiol < 100
All results confirmed on repeat.
Normal UE, LFT, lipids.
SHBG was not measured for either of these patients as the testosterone was well into the normal range in both cases.
All comments gratefully received!
Kind Regards
Fiona Davidson
Senior Clinical Biochemist
Kingston Hospital
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