October 2018

54yo male with weight gain and irritability


54yo male presents to clinic with referral from endocrinology. 
Initially presented two years ago to primary care doctor with sexual dysfunction, found to have low testosterone level. Prescribed monthly injections. 
Over a 6 month period he developed 20lbs unintentional weight gain, noticeably between the shoulder blades. 
Increasing anger/irritability


BP 143/79 Pulse 82 Resp 18
Extra-ocular movements intact
No nystagmus
Visual fields normal bilaterally
Face symmetric
No dysmetria
5/5 strength in all extremities
Decreased muscle mass in proximal arms/legs
Truncal obesity
Buffalo hump


Testosterone 107 (300-890ng/dl)
Prolactin 6.7 (1-18ng/dl)
LH 4.7 (1.6-8mIU/ml)
FSH 7.5 (1.5-12.4mIU/ml)
T4 1.06 (0.6-1.15ng/dl)
Am Cortisol 17.2 (6-22ug/ml)
ACTH 81 (0-46pg/ml)
HgA1C 7.0(4.5-6.2%)

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