Hello, I am trying to figure out if my husband could have pituitary gland disorder.

Patient

Q: Hello, I am trying to figure out if my husband could have a pituitary disorder. For the last two years he has had consistently low levels of testosterone with normal levels of LH and FSH. A year ago blood work showed he had low total t4 but normal TSH. This week his free t3 and free t4 were as low as they could get withing normal range. His t4 was .8 and that was the lowest in the range. However, his TSH was on the low end of normal.

Despite undergoing testosterone replacement therapy for a year his levels never increased. He has developed severe mood problems and was diagnosed Bipolar type 2 a year ago after a hospitalization. He has very severe depression and absolutely no energy. He never has euphoric mania. He only experiences periods of terrible rage consistent with IED, racing thoughts, and the need for activity. Even in his high states he has no energy. Growing up he was overweight but lost 60 pounds. Later he rapidly gained a hundred pounds and lost a patch of hair out of his beard. He has always felt bad about his chest as well and felt that even at his thinnest he too much fat there.

He has been rapid cycling and experiencing mixed states. Also, he has not had any break or normal period since suddenly developing his mood problems two years ago. I do not understand why his pituitary sending hormones do not increase when he has low levels of hormones such as thyroid and testosterone. Is it possible he has an endocrine problem worsening bipolar? Or could the bipolar be a misdiagnosis?

Doctor

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