Hypopituitarism and how to deal with it

[pepous]

Hello,

I would like to consult with you my case. I am 24 old man and from my puberty I suffer from some issues.

Sympthoms:

1. Energy swings (sometimes I have letargy and sometimes I have energy throughout the day - letargy more often)
2. Low asertivity
3. Tendencies to anxieties or depressions
4. Low libido (but sometimes my libido is good - It is related to energy swings)
5. Dry skin and oily / dry hair
6. Blood sugar problems sometimes while doing sport
7. Digestive issues
8. Easily burnout
9. Sensitive to many things (fried food, or white wheat etc. makes me lethargy)


My stats:
Age: 24
Height: 180 cm
Weight: 76 Kg

Diet:

I prefer eating mainly raw food. I eat about 100 g / proteins daily and a lot of fats and carbs. Still more carbs than fats but I do prefer more and more good fats.

Excerice:

I do excerices around 3 - 4 / week usually. I am riding bike or going to gym.

History of testing:

I have 2mm microadenom on my pituitary. Doctor said it is too small to cause problems but there is no other reason in my eyes why my pituitary is working this way.

Also few months ago I had a lot of stress during one week. The day after big event I got sick. From that moment I may say that my values got worse but bellow I am sending entire my history.

Also about one year ago I tried anastrozole to increase my testosterone / estradiol ratio. But didnt worked long term for me. Worked fine for 2 monts but than anxieties started again. And was not able to find stable dose which would stabilize me long term.

Blood test 1 (2 years or more old) - Not any drugs - Measured in early morning

LH 2,5 U/L <1,2 - 8,6>
THS 3,32 mU/L <0,34 - 5,60>
Free T4 10,1 pmol/l <7,9 - 16,0>
Free t3 5,1 pmol/l <3,8 - 6,0 >
T4 total 90,01 nmol/l <78,00 - 157,00>
T3 total 1,68 nmol/l <1,34 - 2,73>
FSH 2,7 U/l <1,3 - 19,3>
Estradiol 130 pmol/l <0 - 173>
Prolaktin 408,7 mIU/l <56,0 - 278,0>
Testosteron 14,1 nmol/l <6,1 - 27,1>
SHBG 25,0 nmol/l <13,2 - 89,5>
FAI ( free androgen index ) 56,4 % <22,2 - 110,2>

Testes and thyroid gland was reviwed as OK by sono.
All E2 results are not a sensitive panels. Not possible to check it in Czech r. Also in Czech no possible to check RT3.

Blood test 2 (2 years or more old) - Measured in early morning

UREA = 6.7
KREAJ=92
EGFRM1=1,42
BIL = 8.3
ALT=0.59
AST=0.38
CRP=0.7
PGLU=4.51
CHOL=4.56
LDL=2.89
prolactin=22.93 (ref. range is up to 15 doc sayed)
U-GLU=normal
U-PROT=stopy
U-BIL=negative
U-UBG=normall
U-PH5=5.5
U-Blood=Negative
U-NITR=Negative
U-LEURO=2 (higher than range)


Blood test 3 - This blood test was done 3 hours after I woke up - Prolactin is now lowered

igf-1 290 <265-410>
STH 0,03 <0-20>
SHBG 38.1 <12-75>
LH 2.26 <1,5-9,3>
FSH 2.43 <1.4-18.10>
Prolactin 12.04 <2.1-17.7>
Estradiol <0.09 <0.04-0.19>
Korizol 504 <118-618>
testosterone 12.5 <5.4-30.4>
T4 - free 15.9 <11.5-22.7>
TSH 1.707 <0.5-4.9
ACTH 28.2 <10-60>



Blood test 4

Na 141 <136-145>
K 4,1 <3,5-5,1>
CI 104 <98-107>
Ca 2,35 <2.15-2.55>
Mg 0.8 <0.66-1.07>
Cu 10.9 <12.4-20.6>
Zn 17.7 <7-23>
Glukosa 4.63 <3.33-5.59>
Fe 12 <10.6-28.3>


Blood test 5

Minerals
Na 142 <137 - 146>
K 4,3 <3,8 - 5,0>
CI 100 <97 - 108>
Ca 2,57 <2,00 - 2,75>
Fosfor anorg. 1,07 <0,65 -1,61>
Iron 26,1 <7,2 - 29>
Copper 15,3 <10,99 - 21,98>
Zinc 23,3 <9,1 - 13,7>
Osmolality 292 <275 - 295>
Ferritin 134,6 <22 - 322>
Glucose 4,6 < 3,9 - 5,6>

Urea 5,8 <2,8 - 8>
Kreatinin 95 <44 - 110>

Liver function tests
Bilirubin total 17,6 <2 - 17>
ALT 0,51 <0,1 - 0,78>
AST 0,37 <0,1 - 0,72>
GGT 0,25 <0,14 - 0,84>
ALP 1,01 <0,66 - 2,2>

Proteins

Albumin 50,6 <35 - 53>
Protein total 79,6 <65 - 85>

Lipids

Cholesterol 4,66 <2,9 - 5>
Triacylglyceroly 0,78 <0,45 - 1,7>
Cholesterol HDL 1,44 <1 - 2,1>
Cholesterol LDL 2,87 <1,2 - 3>

Hormones
IGF-I 342,9 <265 - 410>
STH 0,17 <0 - 20>
LH 1,41 <1,5 - 20>
FSH 2 <1,5-9,3>
Prolactin 16,59 <2,1 - 17,7>
Estradiol < 0,090 <0,04 - 0,19>
Progesteron 0,8 <0,9 - 3,9>
Cortizol 594 <118 - 618>
Testosteron 13,57 <5,4 - 30,4>

T3 total 1,45 <0,9 - 3>
T4 total 110,7 <60 - 150>
T4 Free 16,2 <11,5 - 22,7>
TSH 2,509 <0,5 - 4,9>
Anti Tg <15 <0,0 - 60>
Anti TPO 28 <0 - 60>

PSA 0,66 <0,0 - 1,4>
ACTH 40 <10 - 60>

Leukocyts 6,8 <4,1 - 10,2>
Erytocyts 5,44 <4,19 - 5,75>
Hemoglobin 164 <135 - 174>
Hematokrit 0,469 <0,390 - 0,510>

Blood test 6 ( - test was done at 3.2.2014)

Vit. B12 413 <141-489>
TSH 1,29 <0,27 - 4,2>
FT4 Free 16,5 <12 - 22>
FT3 Free 4,9 <3,1 - 6,8>
FSH 3,8 < 0 - 12,4>
LH 4,1 <1,7 - 8,6>
Estradiol 49,4 <28 -156>
Prolactin 10,79 <4,04 - 15,2>
Testosteron Total 15,25 <8,64 - 29>
Kortizol 292,6 <171 - 536>


Anastrozole experiment

At 6.2.2014 (February 6 2014)

I started using Anastrozole at dosing of 0,20 Mg / twice a week. My goal was to improve the testosterone and estradiol ratio, to boost LH, FSH and Testosterone levels .

Blood test results from 17.3.2014 (March 17 2014)

FT4 17,25 <12-22> +0,75 (compared to bloodwork done at 3.2.2014 - Before starding Anastrozole low dose protocol)
FT3 4,9 <3,1-6,8> +-0
FSH 4,5 <1,5-12,4> +0,7
LH 3,4 <1,7-8,6> -0,7
Estradiol 27,2 <28-156> -22,2
Testosterone 18,29 <8,64-29> +3,04

Until 10.4.2015 (2 months) I felt much better than ever before in my history. But one day I started feeling anxieties. So I decreased dose and felt few days good. Than anxieties agains so I changed the dose again and never than find a stable dose when I felt good.

Next blood work results (no drug usage from 7.8.2014) - In 2 weeks before this test I had a lot of stress and after the stres I god "flue". From this moment values got worse I believe.

TSH 2,1 <0,27 - 4,2>
FT4 free 14,9 <12 - 22>

LH 2,6 <1,7 - 8,6>
Testosteron 11,13 <8,64-29>
Estradiol 47,6 <28-156>
Prolactin 8,28 <4,04 - 15,2>
Early morning Cortisol 568 <171 - 536> (doctor checked as a possible culprit of my fatigue).


Blood tests from 21.1.2015
Thyroids:
TSH 1,66 <0,27 - 4,2>
FT4 14,3 <12-22>
FT3 4 <3,1 - 6,8>
T4 total 75,6 <66 - 181>
T3 total 1,1 <1,2 - 3,1>
AntiTG <20 <0 - 40>
AntiTPO <10 <0-35>
(RT3 is unfortunately not measured in Czech)



Other hormones:
LH 1,7 <1,7 - 8,6>
Estradiol 66,5 <28 - 156>
PRL 9,04 <28 - 156>
Testosteron 10,65 <8,64 - 29>
Kortizol 270 <171 - 536>


Blood test from 10.2.2015

Mg 0,88 <0,66-1,07>
CU (m&#283;&#271 9,3 <12,4-20,6>
CU free 1,1 <0-1,6>
ALT 0,5 <0-0,68>
AST 0,46 <0-0,62>
GMT 0,21 <0-1>
ALP 0,93 <0 - 2,15>
Fe 22,8 <10,6 - 28,3>
Ceruloplasmin 0,18 <0,15-0,30>

Blood testing from 4.3.2015

Metanefrin 0,051 <0,140 - 0,540>
Normetanefrin 0,354 <0,130-0790>

Saliva testing from 18.3.2015

18.3.2015
	7:00	12:00	17:00	22:00
Cortisol high	24	8	7	3
Cortisol low	13	5	4	1
Cortisol	15,6	6,9	8,5	9,4

So what do you think? Where to start? What does it appear to you is my main problem? Steroids / thyroids / adrenals?

Thank you very much for any review.

 

[CoastWatcher]

You noted that you were taking astronozole, what, if anything, have you taken/are currently taking? Prescriptions? Supplements?

 

[pepous]

I am not taking anything except Vit. C, D and fish oil. Anastrozole I was taking only for 2 months.

 

[Vettester Chris]

Pep, thanks for joining! So very sorry you are having to endure all of this at such a young age! You posted a ton of details, which is great! Just might have to address certain blocks of it.

So what I gather is that you have a small anedomea on the pituitary, and your physician has determined that it is responsible for your disorders with your endocrine system? Just to confirm have you, or were taking any anabolic steroids, corticosteroids, prohormones, or anything that could contribute to some of this? I don't think you were, but just double checking.

The rhythm of your circadian profile is definitely a concern. At first glance it seems to resemble Cushing's, which would/could be secondary hypercorticism, attributed from the anedomea?!? ... Curious if your doctor has officially diagnosed this?

You see your thyroid reading are also quite low ... I don't imagine the results with a Reverse T3 lab would offer all that much optimism. The cortisol subject will be problematic with being able to dial-in your thyroid, so that's something to keep in mind if/when your doctor talks about some form of thyroid medication (Synthoroid, Cytomel, NDT, etc.).

With that said, what is your doctor's plan for treatment, and with getting you on the right track? This is obviously effecting every 'key' hormone you have! If you were here in the US, it would be easier for me to tell you to contact a specialist. I'm not sure how you can go about this in your country? It needs treated!! Your labs speak volumes, and I can only imagine the hurdles you're going through.

 

[pepous]

Hello,

thank you for review.

1. Doctor doent determine anything. Just said (when I asked) that my testosterone may be to cause. If it is caused by microadenom or not no one know.
2. Saliva testing I did by myself not with doctor. This test is not normally did by classic endos. I dont thing adrenall are my root cause. I thing I just need take stress off of my adrenalls. Hormonal disbalancies causing me stress.
3. I dont except RT3 to be high becouse of the ratio of FT3 to RT4. That seems that I convert T4 to T3 well.
4. Doctor has no plan. That depends on me what I want and according to that to find a doctor willing to cowork with me it seems ...

I have two theories / please review if it gives sense:

1. Secondary hypogonadism is the main issue to start with

Why do I think it?

- I always looked younger / had dealyed puberty etc.
- Testosterone will decrease my high cortisol.
- My LH/FSH is constantly low
- Testosterone may increase my thyroids as well

2. Problem is secondary hypothyroidism

- being hypo causes stress to my adrenals
- healing thyroids may increase LH/FSH


But my thyroid profile looks probably better than steroid profile. So I dont know.


Thank you

 

[Vettester Chris]

Hello,

thank you for review.

1. Doctor doent determine anything. Just said (when I asked) that my testosterone may be to cause. If it is caused by microadenom or not no one know.
2. Saliva testing I did by myself not with doctor. This test is not normally did by classic endos. I dont thing adrenall are my root cause. I thing I just need take stress off of my adrenalls. Hormonal disbalancies causing me stress.
3. I dont except RT3 to be high becouse of the ratio of FT3 to RT4. That seems that I convert T4 to T3 well.
4. Doctor has no plan. That depends on me what I want and according to that to find a doctor willing to cowork with me it seems ...

I have two theories / please review if it gives sense:

1. Secondary hypogonadism is the main issue to start with

Why do I think it?

- I always looked younger / had dealyed puberty etc.
- Testosterone will decrease my high cortisol.
- My LH/FSH is constantly low
- Testosterone may increase my thyroids as well

2. Problem is secondary hypothyroidism

- being hypo causes stress to my adrenals
- healing thyroids may increase LH/FSH


But my thyroid profile looks probably better than steroid profile. So I dont know.


Thank you

Pep, I have a little bit to respond to a few of the thoughts ...

On the thyroid, you can't presume RT3 is OK, just because the FT3 lab is in a similar area of the reference range as the FT4. At a glance, it might look like FT4 is converting fine, but in fact the FT3 could just be pooling, not getting into the cells, and FT4 might be shifting the conversion to RT3. It's a common theme with adrenal issues; specifically with cortisol. I don't expect your RT3 to be high either, as your overall thyroid hormone levels are low. However, I'll bet a protein shake that your RT3/FT3 ratio is not adequate!?!?

On your two (2) theories ... Could be "Yes" and "Yes". Hypothyroidism can be linked to Hypogonadism, and vice-verse. Your labs obviously indicate that both of these subjects are in play with you. I agree, the hormonal imbalances are causing a great deal of stress. However, is the pituitary anedomea the underlying problem? The body's natural course isn't to just stop or not produce these hormones. If steroids or other chemical/environmental variables are not a factor, then I'd have to presume the tumor is the culprit (?). I dunno!

One last thought ... TRT could be an option if for some reason your endogenous production is not going to work. However, I'm doubtful at the moment that any attempt to directly correct the thyroid will be successful. If your circadian profile stands, I just don't see FT3 effectively reaching the cells, at least not in an optimal fashion.

It's obviously easier said than done, but the adrenals and your circadian profile need to be improved in order for the thyroid hormone to work. If not, FT3 will just build and pool, which is no good! That's just my read on it, my .02, and there could be 100 other things I don't see here.

 

[pepous]

Thank you Chris for your review.

Becouse I need to make a plan to start with I will summarize it.

1. My steroid profile is not correct at the moment (could be supplemented by TRT or Clomid)
2. Thyroid profile is not great as well but becouse of circadian profile supplementing could not be working (could be supplemented and I believe improved by lifestyle)
3. Adrenall circadian rhytm - the problem is in my eyes in lifestyle changes / food / not working to late nights / avoiding stress, sun exposure etc. + optimalizing of steroid hormones which will calm me down -> T3 may be reaching cells better

So the plan could be (what do you think?)

1. Optimalizing steroid profile (firt by clomid 0,125 / EOD -> If not working TRT)
2. Naturally optimize thyroid profile (by excericising, cold showers, iodine / selenium sup., diet etc.)
3. Optimalize adrenals by avoiding stress, to not push myself to late night working on PC, sun exposure in the morning, alot of rest, vit. C

Does this plan gives sense or do you have other suggestion? I need to start by something.

Thank you.

 

[Vettester Chris]

So the plan could be (what do you think?)

1. Optimalizing steroid profile (firt by clomid 0,125 / EOD -> If not working TRT)
2. Naturally optimize thyroid profile (by excericising, cold showers, iodine / selenium sup., diet etc.)
3. Optimalize adrenals by avoiding stress, to not push myself to late night working on PC, sun exposure in the morning, alot of rest, vit. C

Does this plan gives sense or do you have other suggestion? I need to start by something.

Thank you.

1. With what you have presented, I personally don't think Clomid will hold. Clomid's purpose would be to stimulate GnRH - LH secretion, and thereafter you would want it to sustain. If your HPTA was suppressed from AAS (test, Nor19, etc), then it's a possibility. With an andomea in play, which sounds like the culprit, I would suspect any SERM you try won't be successful. If the tumor is not the culprit, then maybe Clomid stands a chance.

2. Yes, you can always implement selenium, iodine, and do the healthy things that will help your thyroid. The first step though will be getting the adrenals figured out, as it is necessary for T3 reaching the cells and promoting ATP.

3. Definitely focus on the adrenals as mentioned above. Agree with supplements (Vitamin C, Magnesium, D3, etc.). Being you are dealing with hypopituitary, I don't know how effective any of this can be. If it was just stress related, causing adrenal fatigue, then you could look at other options including CT3M.

You ask for my suggestion ... My honest, best suggestion I can give you is to do what it takes to get with a physician, who can really get to the root of this for you, and who can take the measures to treat it properly. If your current doctor is stating that your endogenous testosterone is to blame, then that's not the doctor you need to have for this journey. I know most people might not have the resources to do this, I don't know your situation (?). Maybe there are potential physicians in Poland, Germany, or other countries nearby.

 

[pepous]

Do you think they will really help? If so could you give me contacts? Maybe some of tham is willing to provide phone call consultation.

My idea is that (my mother has similar sympthoms) that simply pituitary is not working properly. So I need to supplement to those hormones which are low.

Thank you

 

[Vettester Chris]

You could try Dr. James Wilson, here in the US, and see if they can do a consultation for you .. http://www.adrenalfatigue.org/contact-us ... They have contact information for outside the US, but I don't know how in-depth they go with patients in other countries. They might also know some reputable physicians & clinics in Europe.