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Based upon limited evidence, the Endocrine Society (ES) guidelines suggest total testosterone (T)\u2009&lt;\u20095.2 nmol\/L to identify patients eligible for MRI. The study aims to identify markers and their best threshold value predicting pathological MRI findings in men with SH.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A consecutive series of 609 men seeking medical care for sexual dysfunction and with SH (total T\u2009&lt;\u200910.5 nmol\/L and LH\u2009\u2264\u20099.4 U\/L) was retrospectively evaluated. An independent cohort of 50 men with SH was used as validation sample. 126 men in the exploratory sample and the whole validation sample underwent MRI.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In the exploratory sample, patients with pathological MRI findings (<jats:italic>n<\/jats:italic>\u2009=\u200946) had significantly lower total T, luteinizing hormone (LH), follicle stimulating hormone (FSH) and prostate specific antigen (PSA) than men with normal MRI (<jats:italic>n<\/jats:italic>\u2009=\u200980). Receiver Operating Characteristics analysis showed that total T, LH, FSH and PSA are accurate in identifying men with pathologic MRI (accuracy: 0.62\u20130.68, all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). The Youden index was used to detect the value with the best performance, corresponding to total T 6.1 nmol\/L, LH 1.9 U\/L, FSH 4.2 U\/L and PSA 0.58 ng\/mL. In the validation cohort, only total T\u2009\u2264\u20096.1 nmol\/L and LH\u2009\u2264\u20091.9 U\/L were confirmed as significant predictors of pathologic MRI.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In men with SH, total T\u2009\u2264\u20096.1 nmol\/L or LH\u2009\u2264\u20091.9 U\/L should arise the suspect of hypothalamus\/pituitary structural abnormalities, deserving MRI evaluation.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s40618-021-01586-5","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T06:02:36Z","timestamp":1620626556000},"page":"2785-2797","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Biochemical predictors of structural hypothalamus\u2013pituitary abnormalities detected by magnetic resonance imaging in men with secondary hypogonadism"],"prefix":"10.1007","volume":"44","author":[{"given":"S.","family":"Cipriani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Todisco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Ghiandai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Vignozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Corona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Maggi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6164-4278","authenticated-orcid":false,"given":"G.","family":"Rastrelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,10]]},"reference":[{"issue":"4","key":"1586_CR1","doi-asserted-by":"publisher","first-page":"1810","DOI":"10.1210\/jc.2009-1796","volume":"95","author":"A Tajar","year":"2010","unstructured":"Tajar A, Forti G, O\u2019Neill TW, Lee DM, Silman AJ, Finn JD, Bartfai G, Boonen S, Casanueva FF, Giwercman A, Han TS, Kula K, Labrie F, Lean MEJ, Pendleton N, Punab M, Vanderschueren D, Huhtaniemi IT, Wu FCW, EMAS Group (2010) Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study. 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According to our clinical practice, each patient underwent a standard diagnostic protocol, which has been approved by our Hospital with the reference ID# L99-A08 292\/2014.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"According to our routine clinical practice, each patient underwent a standard diagnostic protocol, which has been approved by our Hospital with the reference ID#L99-A08 292\/2014.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals"}},{"value":"Informed consent for collecting these data was obtained from each patient. All the procedures are in accordance with the Code of Ethics of the World Medical Association.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}