A 35-year-old man comes to the office with a year-long history of fatigue and weakness. He has had a significant decrease in appetite and interest in day-to-day activities due to lack of energy. He also reports cold intolerance, a dull constant headache, constipation, erectile dysfunction, and low libido. The patient has no fever, neck swelling, skin rash, head injury, or excessive urination. Temperature is 36.6 C (97.9 F) , blood pressure is 98/72 mm Hg, pulse is 50/min, and respirations are 14/min. The skin is dry and pale. Neurologic examination shows delayed deep tendon reflexes. The testes are small and soft on palpation. Laboratory results are as follows: Further evaluation in this patient would most likely show which of the following?

Question

A 35-year-old man comes to the office with a year-long history of fatigue and weakness. He has had a significant decrease in appetite and interest in day-to-day activities due to lack of energy. He also reports cold intolerance, a dull constant headache, constipation, erectile dysfunction, and low libido. The patient has no fever, neck swelling, skin rash, head injury, or excessive urination. Temperature is 36.6 C (97.9 F) , blood pressure is 98/72 mm Hg, pulse is 50/min, and respirations are 14/min. The skin is dry and pale. Neurologic examination shows delayed deep tendon reflexes. The testes are small and soft on palpation. Laboratory results are as follows:

Further evaluation in this patient would most likely show which of the following?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d3c3_47f0_bc81_796a62ad0896_MD0003_00 This patient's presentation suggests panhypopituitarism with inadequate production of multiple anterior pituitary hormones. Potential features include: Central adrenal insufficiency (low cortisol and ACTH) - fatigue, anorexia, hypoglycemia, eosinophilia. Skin may be pale due to decreased production of ACTH and melanocyte-stimulating hormone Hypogonadotropic hypogonadism (low FSH, LH, and testosterone) - low libido, erectile dysfunction, testicular atrophy Central hypothyroidism (low or inappropriately normal TSH, low free T4) - cold intolerance, constipation, bradycardia Patients may have mild hyponatremia (due to antidiuretic hormone release) and mild hypotension (due to decreased peripheral arterial resistance). Unlike cortisol, adrenal aldosterone secretion is regulated primarily by the renin-angiotensin system and is not affected in hypopituitarism. In contrast, in primary adrenal insufficiency, aldosterone production is lost, leading to hyperkalemia and severe hypotension, and ACTH production is increased, with associated hyperpigmentation. Hypopituitarism is often due to compression by pituitary or extrapituitary tumors and may be associated with mass-effect symptoms (eg, headache, visual field defects). Other causes include infiltrative diseases (eg, sarcoidosis, hemochromatosis), trauma, and vascular insults (apoplexy, Sheehan syndrome). Educational objective: Hypopituitarism is characterized by glucocorticoid deficiency, hypogonadism, and hypothyroidism. Typical features include fatigue, cold intolerance, hypoglycemia, anorexia, and low libido. In contrast to primary adrenal insufficiency, aldosterone is normal in central adrenal insufficiency due to hypopituitarism. References: Neurology of the pituitary. (http://www.ncbi.nlm.nih.gov/pubmed/24365347) Dynamic pituitary hormones change after traumatic brain injury. (http://www.ncbi.nlm.nih.gov/pubmed/25033850)

A 35-Year-Old Man Comes to the Office with a Year-Long