Case 12-2000

Abstract

A 60-year-old man was referred to the hospital because of a pituitary macroadenoma.The patient had been well until three years earlier, when he became impotent and his libido decreased. Two months before his referral to this hospital, his nipples became sore. The prolactin level was 33.6 ng per milliliter (normal range, 0 to 15); the total testosterone level was 306 ng per deciliter (10.6 nmol per liter; normal range, 270 to 1070 ng per deciliter [9.36 to 37.1 nmol per liter]). Magnetic resonance imaging (MRI) revealed a mass, 11 mm in diameter, in the right pituitary fossa that caused deviation of the hypophysial stalk to the left of the midline. The mass was hypointense on T 1 -weighted images and was less enhanced than the adjacent pituitary tissue after the administration of gadolinium. It encased the cavernous portion of the right internal carotid artery and extended into the right cavernous sinus. The patient was referred to the neuroendocrine unit of this hospital.The patient was a scientist. He was married and had two adult children. He took lisinopril for hypertension and had undergone coronary angioplasty eight years earlier because of cardiac pain without a myo-*ND denotes not detectable. To convert the values for estradiol to picomoles per liter, multiply by 3.671. To convert the values for thyroxine to nanomoles per liter, multiply by 12.87. To convert the values for unbound testosterone to picomoles per liter, multiply by 34.67. To convert the values for total testosterone to nanomoles per liter, multiply by 0.03467. To convert the values for cortisol to nanomoles per liter, multiply by 27.59. †Normal values are for men in the patient's age group. ‡The total volume of the 24-hour specimen was 1590 ml; the creatinine content was 1383 mg.