October 2018

54yo male with weight gain and irritability

History

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. 
Fatigue
Headaches
Increasing anger/irritability

Exam

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

Labs

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%)

Fig 1

Fig 2

Questions

 
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Your answers will be added to those already obtained and tabulated at the end of the month.