Diagnostic challenges and management a patient with micropenis and pituitary microadenoma

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.