What is the next step?

60-year-old male complains of decreased libido, decreased ejaculation, FBS= 6.5 mmol, increased prolactin, normal FSH and LH.

What is the next step?
A . Testosterone level
B . DM
C . CT of the head
D . NL FBG

View Answer

Answer: C

Explanation:

Prolactinoma is the most common tumor of pituitary gland, comprising up to 45% of all pituitary tumors. Prolactinoma is the most common cause of hyperprolactinemia, which is a common cause of infertility in males and females. Clinical presentation of the prolactinomas are earlier in females compared with males, even when they are very small (microadenoma). This earlier presentation in females is due to greater symptom burden caused by hyperprolactinemia in them.[1] On the other hand, males present late till prolactinoma becomes large in size (macroprolactinoma) and start causing pressure over optic chiasm and presented as visual deterioration or visual field defects. They can also present with decreased libido. So clinical diagnosis of prolactinoma in male patents is late, which can lead to misdiagnosis of microprolactinoma in male patients.

Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205532/