06-21-2011, 10:08 AM
2. Answer d.
He has clear evidence of acquired hypogonadism, with symptoms,
signs, and biochemical support for low testosterone concentrations.
The initial evaluation of hypogonadism should be to distinguish pri-
mary (gonadal) from secondary (central) causes since this indicates
the appropriate approach to further evaluation and therapy. The pro-
lactin concentration is not high enough to strongly suggest a pituitary
prolactinoma and may reflect the stress of drawing a blood sample or
of concurrent illness. MRI cannot be performed in a patient with a
pacemaker in situ. Although testosterone replacement would cor-
rect the low testosterone, this is not an appropriate treatment for this
man with probable central hypogonadism, which may reflect his
untreated sleep apnea.
Good luck
He has clear evidence of acquired hypogonadism, with symptoms,
signs, and biochemical support for low testosterone concentrations.
The initial evaluation of hypogonadism should be to distinguish pri-
mary (gonadal) from secondary (central) causes since this indicates
the appropriate approach to further evaluation and therapy. The pro-
lactin concentration is not high enough to strongly suggest a pituitary
prolactinoma and may reflect the stress of drawing a blood sample or
of concurrent illness. MRI cannot be performed in a patient with a
pacemaker in situ. Although testosterone replacement would cor-
rect the low testosterone, this is not an appropriate treatment for this
man with probable central hypogonadism, which may reflect his
untreated sleep apnea.
Good luck