Endocrine Abstracts

This is a 46 year old man who was referred by GP for erectile dysfunction. He is a married with two daughters. His complaint started 1 year back with lethargy and tiredness. He is fit and well. He does not take any regular medication. He is shaving regularly. On examination, wt 80 kg. All the secondary sexual characteristics were present. No Galactorrohoea. Testes size was normal. His total testosterone level was low. Anterior pituitary hormone profile showed very low LH and FSH. All the other anterior pituitary hormone profile was normal. No complain of headache or visual disturbance. On MRI of pituitary, it showed pituitary macroadenoma and touching the optic chiasma. We have done the formal visual field testing. Bloods: TSH-2.4, Testosterone-0.5, Prolactin-359, FSH-1.4, LH-0.9.

Questions:: 1. How to manage this case?

2. How should we follow up?