Pituitary evaluation in patients with low prostate-specific antigen

Andjela T Drincic, Anh Thu Nguyen, Shilpi Singh, Mohsen Zena, Ryan Walters, Kathryn Friedman, Robert J. Anderson

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate pituitary function in men with a low screening prostate-specific antigen (PSA) of ≤0.1 ng/mL and test the hypothesis that low PSA is associated with hypogonadism alone or other hormone deficiency. Methods: This was a case-control study evaluating the rates of hypogonadism and low insulin-like growth factor (IGF)-1 in a cohort of men with low or normal screening PSA level. Sixty-four men >40 years old without known prostate disease were divided into a low-PSA group (PSA ≤0.1 ng/mL) and normal-PSA group (PSA 1 to 4 ng/mL). Hormonal evaluation included total testosterone, prolactin, luteinizing hormone, follicle-stimulating hormone, IGF-1, growth hormone, thyroid-stimulating hormone, free thyroxine, morning cortisol, and adrenocorticotropic hormone. The difference between each patient's observed IGF-1 and the IGF-1 age-specific lower limit was calculated. The odds ratios (ORs) for having hypogonadism and associated 95% confidence intervals (CIs) were calculated using the Cochran-Mantel-Haenszel test. Results: The rate of hypogonadism was significantly higher in the low-PSA group (n = 44) compared with the normal-PSA control group (n = 20) (45.5% vs. 15.0%; OR, 4.7; 95% CI, 1.2 to 18.4; P = .027). The total testosterone in the low-PSA group was significantly lower compared with the control group (181.7 ng/dL vs. 263.7 ng/dL; P = .008). IGF-1 values were below their lower bound in 18.6% of subjects in the low-PSA group, compared with 0% in the control group. Conclusion: Men with low PSA have significantly higher rates of hypogonadism and low IGF-1 compared with those with normal PSA. In such men, we recommend hormonal evaluation to exclude associated pituitary dysfunction.

Original languageEnglish (US)
Pages (from-to)1030-1037
Number of pages8
JournalEndocrine Practice
Volume24
Issue number12
DOIs
StatePublished - Dec 1 2018

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Prostate-Specific Antigen
Somatomedins
Hypogonadism
Control Groups
Testosterone
Odds Ratio
Confidence Intervals
Follicle Stimulating Hormone
Thyrotropin
Luteinizing Hormone
Thyroxine
Prolactin
Adrenocorticotropic Hormone
Growth Hormone
Hydrocortisone
Case-Control Studies
Prostate
Hormones

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Drincic, A. T., Nguyen, A. T., Singh, S., Zena, M., Walters, R., Friedman, K., & Anderson, R. J. (2018). Pituitary evaluation in patients with low prostate-specific antigen. Endocrine Practice, 24(12), 1030-1037. https://doi.org/10.4158/EP-2018-0204

Pituitary evaluation in patients with low prostate-specific antigen. / Drincic, Andjela T; Nguyen, Anh Thu; Singh, Shilpi; Zena, Mohsen; Walters, Ryan; Friedman, Kathryn; Anderson, Robert J.

In: Endocrine Practice, Vol. 24, No. 12, 01.12.2018, p. 1030-1037.

Research output: Contribution to journalArticle

Drincic, AT, Nguyen, AT, Singh, S, Zena, M, Walters, R, Friedman, K & Anderson, RJ 2018, 'Pituitary evaluation in patients with low prostate-specific antigen', Endocrine Practice, vol. 24, no. 12, pp. 1030-1037. https://doi.org/10.4158/EP-2018-0204
Drincic AT, Nguyen AT, Singh S, Zena M, Walters R, Friedman K et al. Pituitary evaluation in patients with low prostate-specific antigen. Endocrine Practice. 2018 Dec 1;24(12):1030-1037. https://doi.org/10.4158/EP-2018-0204
Drincic, Andjela T ; Nguyen, Anh Thu ; Singh, Shilpi ; Zena, Mohsen ; Walters, Ryan ; Friedman, Kathryn ; Anderson, Robert J. / Pituitary evaluation in patients with low prostate-specific antigen. In: Endocrine Practice. 2018 ; Vol. 24, No. 12. pp. 1030-1037.
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abstract = "Objective: To evaluate pituitary function in men with a low screening prostate-specific antigen (PSA) of ≤0.1 ng/mL and test the hypothesis that low PSA is associated with hypogonadism alone or other hormone deficiency. Methods: This was a case-control study evaluating the rates of hypogonadism and low insulin-like growth factor (IGF)-1 in a cohort of men with low or normal screening PSA level. Sixty-four men >40 years old without known prostate disease were divided into a low-PSA group (PSA ≤0.1 ng/mL) and normal-PSA group (PSA 1 to 4 ng/mL). Hormonal evaluation included total testosterone, prolactin, luteinizing hormone, follicle-stimulating hormone, IGF-1, growth hormone, thyroid-stimulating hormone, free thyroxine, morning cortisol, and adrenocorticotropic hormone. The difference between each patient's observed IGF-1 and the IGF-1 age-specific lower limit was calculated. The odds ratios (ORs) for having hypogonadism and associated 95{\%} confidence intervals (CIs) were calculated using the Cochran-Mantel-Haenszel test. Results: The rate of hypogonadism was significantly higher in the low-PSA group (n = 44) compared with the normal-PSA control group (n = 20) (45.5{\%} vs. 15.0{\%}; OR, 4.7; 95{\%} CI, 1.2 to 18.4; P = .027). The total testosterone in the low-PSA group was significantly lower compared with the control group (181.7 ng/dL vs. 263.7 ng/dL; P = .008). IGF-1 values were below their lower bound in 18.6{\%} of subjects in the low-PSA group, compared with 0{\%} in the control group. Conclusion: Men with low PSA have significantly higher rates of hypogonadism and low IGF-1 compared with those with normal PSA. In such men, we recommend hormonal evaluation to exclude associated pituitary dysfunction.",
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