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Step 1: View clinicals

A 41-year-old man complains of a decreased libido for three months, in association with easy fatigability. Upon further assessment, he reveals that he has also experienced erectile dysfunction during the same time period. He is otherwise healthy, and denies headaches or visual disturbances. His medical history is unremarkable and he is not on any medications. There is no history of exposure to radiation. He only drinks socially, and has never smoked or used recreational drugs. At a routine checkup a month ago, a hemoglobin A1c (HbA1c) and lipid profile were normal. A complete blood count reveals normal hemoglobin levels (12.9 g/dL).

Step 2: Order all relevant investigations

Endocrine Profile

TSH: 2.17 mIU/L (0.4 - 4.5) Serum prolactin: 210 ng/mL (2 - 18) Testosterone: 161 ng/dL (249-836) Cortisol, FSH, LH: Within normal parameters. GH suppression test: Within normal parameters

Liver + Renal Profiles

AST: 35 U/L (10 - 40) ALT: 14 U/L (7 - 56) ALP: 62 U/L (45 - 115) GGT: 17 U/L (9 - 48) Albumin: 4.3 g/dL (3.5 - 5.0) Serum creatinine: 0.9 mg/dL (0.6 - 1.2) BUN: 15 mg/dL (7 - 20)

Gadolinium MRI Brain

The gadolinium enhanced MRI reveals a sellar mass 5mm x 8mm in size, suggestive of a pituitary microadenoma.

CT Cavernosography

CT cavernosography shows no leakages in the penile venous system.

Step 3: Select appropriate management

Transsphenoidal Resection

Score: ★★☆