Diagnostic challenges and management a patient with micropenis and pituitary microadenoma

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Bali Medical Journal Pub Date : 2022-11-30 DOI:10.15562/bmj.v11i3.3828
I. Putu, Surya Pridanta, Deasy Ardiany
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Abstract

Background: Micropenis is a condition where the penis size is smaller than 2.5 standard deviation on average without any anatomical malformations. Hypogonadotropic hypogonadism is one of the causes of micropenis and one of the structural disorders that could lead to hypogonadotropic hypogonadism is a pituitary microadenoma that alters the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. In this case-report we present a patient with micropenis caused by pituitary adenoma. Case presentation: A 40-year-old male patient, presented to Dr Soetomo Hospital with a chief complaint of having a small penis that did not match the proportions of the body but could still erect and ejaculate. The patient experienced fatigue for about two months before the admission and struggled to concentrate while walking for the last six months. The laboratory results were hyperprolactinemia, hypo albumin, and dyslipidemia. From the MRI examination with contrast, a mass was found in the left pituitary. The patient was diagnosed with pituitary microadenoma, hypogonadotropic hypogonadism, micropenis, hypotestosterone, hypocortisolism, and hypothyroidism. The patient was assigned for monthly monitoring. Consultation with a neurosurgeon suggested there were no indications for surgery. The patient was treated with testosterone intramuscular injection 250 mg every month, methylprednisolone 4 mg every 8 h, simvastatin 20 mg every 24 h, and levothyroxine sodium 50 mg every 24 h. One month follow up, fatigue was disappeared and nine months follow up found improvements in hormone levels and balance during walking. Conclusion: Pituitary microadenoma can manifest as micropenis, hypocortisolism, and shift hormone levels. The main therapy for pituitary microadenoma is hormone therapy as presented this present case report.
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小阴茎和垂体微腺瘤患者的诊断挑战和治疗
背景:小阴茎是指阴茎大小平均小于2.5标准差,且无任何解剖畸形。促性腺功能低下是导致小阴茎的原因之一,也是导致促性腺功能低下的结构性疾病之一。促性腺功能低下是一种垂体微腺瘤,可改变促卵泡激素(FSH)、黄体生成素(LH)和睾丸激素的水平。在这个病例报告中,我们提出了一个由垂体腺瘤引起的小阴茎患者。病例介绍:一名40岁男性患者,以与身体比例不匹配的小阴茎为主诉来到Soetomo医生医院,但仍能勃起和射精。患者在入院前大约两个月感到疲劳,在过去的六个月里,行走时难以集中注意力。实验室结果为高泌乳素血症、低白蛋白和血脂异常。经MRI对比检查,发现左垂体有肿块。患者被诊断为垂体微腺瘤、促性腺功能减退、小阴茎、低睾酮、低皮质醇和甲状腺功能减退。患者每月接受监测。向神经外科医生咨询后认为没有手术的迹象。患者给予肌肉注射睾酮250 mg /月,甲基强的松龙4 mg / 8 h,辛伐他汀20 mg / 24 h,左旋甲状腺素钠50 mg / 24 h。随访1个月,疲劳消失,随访9个月,激素水平及行走平衡改善。结论:垂体微腺瘤可表现为小阴茎、低皮质醇、激素水平变化。垂体微腺瘤的主要治疗方法是激素治疗。
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来源期刊
Bali Medical Journal
Bali Medical Journal MEDICINE, GENERAL & INTERNAL-
自引率
50.00%
发文量
8
审稿时长
3 weeks
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