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Diagnostic challenges and management a patient with micropenis and pituitary microadenoma

  • I Putu Surya Pridanta ,
  • Deasy Ardiany ,

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.

References

  1. Hatipoğlu N, Kurtoğlu S. Micropenis: etiology, diagnosis and treatment approaches. J Clin Res Pediatr Endocrinol [Internet]. 2013;5(4):217–23. Available from: https://pubmed.ncbi.nlm.nih.gov/24379029
  2. Fahmita KD, Ardiany D. Dilemma on Indonesian adult with micropenis during COVID-19 pandemic: A case report and review article. Ann Med Surg [Internet]. 2022/07/31. 2022 Aug;80:104244. Available from: https://pubmed.ncbi.nlm.nih.gov/35936571
  3. Jiang X, Zhang X. The molecular pathogenesis of pituitary adenomas: an update. Endocrinol Metab (Seoul, Korea) [Internet]. 2013 Dec;28(4):245–54. Available from: https://pubmed.ncbi.nlm.nih.gov/24396688
  4. Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, et al. The prevalence of pituitary adenomas. Cancer [Internet]. 2004;101(3):613–9. Available from: http://dx.doi.org/10.1002/cncr.20412
  5. Destiansyah RA, Savitri CMA, Wisnawa IWW, Susilo RI, Wahyuhadi J, Haq IBI. Remote extradural hematoma as a complication of endoscopic transsphenoidal surgery: A case report with literature review. Int J Surg Case Rep [Internet]. 2022 Jun 23;96:107341. Available from: https://pubmed.ncbi.nlm.nih.gov/35763970
  6. Aljabri KS, Bokhari SA, Assiri FY, Alshareef MA, Khan PM. The epidemiology of pituitary adenomas in a community-based hospital: a retrospective single center study in Saudi Arabia. Ann Saudi Med [Internet]. 2016;36(5):341–5. Available from: https://pubmed.ncbi.nlm.nih.gov/27710986
  7. Faizi M, Dyah T, Lita S, Netty E. Penile length of newborn infants in dr. Soetomo hospital Surabaya. A preliminary study. Folia Medica Indonesiana. 2011;47(1):64-70.
  8. Mahmud AA, Anu UH, Foysal KA, Hasan M, Sazib SM, Ragib AA, et al. Elevated serum malondialdehyde (MDA), insulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH), and reduced antioxidant vitamins in polycystic ovarian syndrome patients. Narra J [Internet]. 2022;2(1). Available from: http://dx.doi.org/10.52225/narra.v2i1.56
  9. Wiygul J, Palmer LS. Micropenis. ScientificWorldJournal [Internet]. 2011 Jul 28;11:1462–9. Available from: https://pubmed.ncbi.nlm.nih.gov/21805015
  10. Ramadhani MZ, Renaldo J. Pre-Operative Hormonal Administration in Hypospadias Patients Undergoing Urethroplasty. Folia Medica Indones [Internet]. 2022;58(1):80. Available from: http://dx.doi.org/10.20473/fmi.v58i1.32182
  11. Ranke MB, Wit JM. Growth hormone — past, present and future. Nat Rev Endocrinol [Internet]. 2018;14(5):285–300. Available from: http://dx.doi.org/10.1038/nrendo.2018.22
  12. Cao Y, Wang F, Liu Z, Jiao B. Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery. Exp Ther Med [Internet]. 2016/03/02. 2016 May;11(5):1977–82. Available from: https://pubmed.ncbi.nlm.nih.gov/27168837
  13. Crawford M, Kennedy L. Testosterone replacement therapy: role of pituitary and thyroid in diagnosis and treatment. Transl Androl Urol [Internet]. 2016 Dec;5(6):850–8. Available from: https://pubmed.ncbi.nlm.nih.gov/28078216
  14. Russ S, Anastasopoulou C, Shafiq I. Pituitary adenoma. In: SpringerReference [Internet]. Springer-Verlag; Available from: http://dx.doi.org/10.1007/springerreference_39442
  15. Jane JA, Jr., Catalino MP, Laws ER. Surgical Technique for Pituitary Adenomas [Internet]. Sellar and Parasellar Tumors. Georg Thieme Verlag; 2012. Available from: http://dx.doi.org/10.1055/b-0034-81957

How to Cite

Pridanta, I. P. S., & Ardiany, D. . (2022). Diagnostic challenges and management a patient with micropenis and pituitary microadenoma. Bali Medical Journal, 11(3), 1817–1821. https://doi.org/10.15562/bmj.v11i3.3828

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I Putu Surya Pridanta
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Deasy Ardiany
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