Diagnosis

These diseases are characterized by extensive damage to pituitary function. Therefore, hypogonadism is rarely reported as an isolated manifestation but, instead, is frequently associated with hypopituarism and diabetes insipidus. In addition, headache, vomiting, ophthalmoplegia, and visual loss occur with acute onset in pituitary apoplexy or head trauma and occur progressively in the empty sella syndrome, infectious and inflammatory processes, mucocele, arachnoid cyst, giant cell granuloma, and echinococcal cystis (90).

Considering the importance of hypopituitarism in hypogonadism induction, anterior pituitary function testing (GnRH stimulation to assess gonadotroph function by measuring FSH and LH, insulin tolerance testing to assess corticotroph and somatotroph secretion by measuring serum cortisol and GH levels, and TRH stimulation test to assess TSH levels), blood PRL profile, as well as measurement of the serum testosterone level and the semen analyses, are mandatory in this group of patients (90).

Currently, MRI is an essential tool in the differential diagnosis of sellar masses and in the evaluation of head trauma. However, biopsy and histology are often necessary to confirm the diagnosis (19).

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