Usually in men with secondary hypogonadism due to hypopituitarism, the

serum testosterone level and sperm count are very low, and LH and FSH
levels are distinctly low or, less commonly, in the low-normal to slightly
low range. The gonadotropin response to acute or chronic
GnRH stimulation is not a clinically useful differential
diagnostic test because it does not reliably distinguish
between pituitary and hypothalamic disease causing
gonadotropin deficiency in hypopituitarism. If hypopitu_x0002_itarism is
suspected on the basis of the initial clinical and
laboratory evaluation, further evaluation should include
hypothalamic-pituitary imaging, preferably an MRI with
gadolinium contrast enhancement, which can better define
the presence and extent of hypothalamic and pituitary
disease compared with a computed tomographic scan
(although the latter is able to detect pituitary macroade_x0002_noma and microcalcifications found
frequently in cranio_x0002_pharyngioma); formal visual field examination; and
investigation of anterior pituitary hormone deficiency or
excess.
Treatment is aimed at the underlying cause of the
hypopituitarism and treatment of pituitary hormone
deficiency, including treatment of androgen deficiency
secondary to gonadotropin deficiency with testosterone
replacement therapy. With transsphenoidal surgical
treatment of pituitary adenomas, pituitary function is
improved in approximately 50% of cases. Dopamine
agonist treatment of prolactin-secreting pituitary adenomas
improves pituitary function in 60% to 75% of cases.
If fertility is desired, testosterone treatment is stopped
and gonadotropin therapy is initiated, initially with
hCG.
In men with acquired gonadotropin deficiency without
coexisting testicular disease, hCG treatment alone may
stimulate spermatogenesis to levels sufficient to
restore fertility.