Differentials
Klinefelter syndrome
SIGNS / SYMPTOMS
Puberty is usually completed. Biochemical and clinical hypogonadism develops from late puberty.[45][46]
Tall stature, with disproportionately long legs in 30%.[46]
Childhood behavioral differences and developmental delay, especially affecting speech.[45] Anger-management and relationship issues affecting employment in adult life.[47]
High risk of venous thrombosis, unrelated to testosterone treatment.[48]
Central adiposity and threefold increased risk of type 2 diabetes.[49]
Pituitary macroadenoma
SIGNS / SYMPTOMS
Headache and bitemporal hemianopia symptoms related to other pituitary hormonal deficiencies; for example, weight loss and nausea due to adrenal insufficiency, or cold intolerance and constipation due to hypothyroidism.
INVESTIGATIONS
Low luteinizing hormone and follicle-stimulating hormone levels with pituitary macroadenoma.
Possible low thyroxine, triiodothyronine, and cortisol levels.
MRI of the pituitary reveals pituitary lesion.
Prolactin may be modestly raised, but tumor fails to shrink with dopamine-agonist treatment.
Prolactinoma
SIGNS / SYMPTOMS
Headache, bitemporal hemianopia, and occasional galactorrhea.
INVESTIGATIONS
MRI of the pituitary reveals pituitary lesion.
Serum prolactin markedly elevated.
Tumor shrinks with dopamine-agonist treatment.
Hyperprolactinemia
SIGNS / SYMPTOMS
Galactorrhea (exceptionally rare in males).
Headache may be present if hyperprolactinemia is secondary to prolactinoma.
INVESTIGATIONS
Elevated prolactin levels. Hypothyroidism and dopamine antagonists should be excluded.
Depression
SIGNS / SYMPTOMS
Depression resulting in reduced libido.
Psychogenic erectile dysfunction.
INVESTIGATIONS
With a primary depressive disorder, hormonal tests will usually be normal.
Normal early morning erections will still occur if erectile dysfunction is psychogenic.
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