MKSAP: 34-year-old man with fatigue, low libido, and infertility

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 34-year-old man is evaluated for a 2-year history of fatigue, low libido, and infertility. His family history is notable for a brother with infertility. His medical history is unremarkable, and he takes no medications. On physical examination, vital signs are normal. His height is 195.6 cm (77 in), and his weight is 86.2 kg (190 lb). Genital examination reveals small, firm testes bilaterally. Laboratory studies reveal a morning serum total testosterone level of 140 ng/dL (4.9 nmol/L) (which was confirmed on repeat testing), a serum follicle-stimulating hormone level of 24 mU/mL (24 U/L), and a serum luteinizing hormone level of 18 mU/mL (18 U/L). Repeated semen analyses reveal azoospermia. Which of the following is the most appropriate diagnostic test to perform next? A: Karyotype B: MRI of the pituitary C: Scrotal ultrasound D: Serum prolactin measurement Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Endocrinology Source Type: blogs