Endocrinology, Diabetes, and Metabolism Board Review #2 Rob ...

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• A 32-year-old man is evaluated for a 5-month history of poor libido, constant
fatigue fatigue, and erectile dysfunction dysfunction. The patient has chronic pain from a motor
vehicle accident 3 years ago in which he sustained back trauma. Although the
pain is largely controlled with sustained-release oral morphine and his
functional status is good, his quality of life is poor because of the fatigue and
lack of sex drive. He takes no other medications.
• On physical examination, examination vital signs are normal, normal and BMI is 35. 35 Visual fields are
full to confrontation. There is no gynecomastia. Testes volume is 15 mL
(normal, 18–25 mL) bilaterally. The penis appears normal.
• Laboratory studies:
– Cortisol (8 AM) 20 µg/dL (552 nmol/L) (normal range, 5-25 µg/dL [138-690 nmol/L])
– Follicle-stimulating hormone 0.2 mU/mL (0.2 U/L)
– Insulin-like growth factor 1 Normal
– Luteinizing hormone 0.1 mU/ml (0.1 U/L)
– Prolactin 12 ng/mL (12 µg/L)
– Sex hormone binding globulin Normal
– Testosterone, total 167 ng/dL (5.8 nmol/L)
– Thyroid-stimulating hormone 1.6 µU/mL (1.6 mU/L)
– Thyroxine (T4), free 1.7 ng/dL (21.9 pmol/L)
– An MRI of the pituitary gland shows normal findings.