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* Endocrine Q 2?
  mounika1980 - 01/06/17 07:41
  A 62-year-old man complains of a 5-year history of progressive erectile failure and recent loss of libido. He acknowledges worsening fatigue and lethargy, morning headaches, and about 6.8 kg of weight gain over the past year, but he denies other neurologic symptoms. He has become less physically active in recent
years because of his occupation as a business manager. His current medications include atorvastatin 20 mg daily, aspirin 81 mg daily, and atenolol 50 mg daily, prescribed for high blood pressure 10 years ago. A permanent pacemaker was inserted for heart block 6 years ago. On physical examination, he is overweight
with abdominal adiposity. His pulse is 68 beats per minute and the blood pressure is 144/86 mm Hg. There is assymetric (right > left) gynecomastia, with mild breast tenderness bilaterally. Testicular examination reveals normal-sized testes (20 mL), which are soft. Male secondary sexual characteristics are normal. His visual fields are normal to confrontation. A CT scan reveals no evidence for a pituitary macroadenoma. Laboratory data include the following: total testosterone 127 ng/dL, TSH 0.8 mIU/L, free thyroxine 0.9 ng/dL, morning cortisol 18 mcg/dL, prolactin 35 ng/mL, sodium 138 mEq/L, potassium 4.2 mEq/L, and creatinine 1.2 mg/dL.

What would you do next?

a. Refer to a neurosurgeon for transsphenoidal surgery.
b. Prescribe bromocriptine or other dopamine-agonist therapy.
c. Prescribe testosterone supplementation through a percutaneous route.
d. Check serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) concentrations.
e. Perform an MRI to obtain adequate imaging of the pituitary gland.
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* Re:Endocrine Q 2?
  dermat - 01/07/17 14:08
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* Re:Endocrine Q 2?
  hesslid - 01/10/17 16:46
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