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Dr Vinson's communication regarding the use of CT scans in the screening of men with infertility and hypogonadotropic hypogonadism deserves a thoughtful response with clarification of our views on the radiological approach to such patients. We appreciate that fourth-generation CT scans with thin section through the sella and coronal and sagittal reconstruction provide considerable discriminating power and are able to detect microadenomas not discernible with standard anteroposterior and lateral "cone down" views of the sella. The described CT method is now widely, but not universally, available; despite its obvious advantages, it has the following several disadvantages: (1) cost—$500 to $800 v $20 for cone down roentgenograms and (2) radiation exposure to the eyes—12 to 40 rad v 3 to 4 rad for cone down roentgenograms. The decision of which approach to use in initial screening depends on the patient selection process. Most patients we see with hypogonadotropic hypogonadism
Swerdloff RS, Hieshima G. Detection of Pituitary Tumors-Reply. JAMA. 1982;248(21):2834-2835. doi:10.1001/jama.1982.03330210026016