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CPE-006 · synthetic case TESTO-FX-06
Headache, visual field loss and prolactin 310
Possible pituitary mass effect.
Purpose: Possible pituitary mass effect.
Inputs the engine received
Testosterone and hormones
- Total testosterone, sample 1
- 90 ng/dL
- Prolactin
- 310 ng/mL
Symptoms and findings
- Age
- 37 years
- Low libido
- Yes
- Severe headache or visual field loss
- Yes
What the engine reports
Severe headache or visual field loss with low testosterone or raised prolactin needs urgent assessment, not the routine outpatient pathway.
A raised prolactin can suppress testosterone and may reflect a pituitary lesion, medication or another cause. Consider pituitary imaging when it is clearly raised, review prolactin-raising drugs, hypothyroidism and macroprolactinemia, and address the cause before testosterone therapy is weighed.
Detected clinical pattern
Urgent Review Finding
A safety rule calls for urgent clinical assessment. Read the safety findings first.
- Pattern: low testosterone single sample
Why this pattern was identified
- Low total testosterone, not confirmed. 90 ng/dL is below 300 ng/dL (AUA); second sample not entered. Confirmation on a separate fasting morning sample is required before it is acted on.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Urgent assessment for a pituitary lesion.
- 2Consider pituitary imaging; review prolactin-raising drugs, hypothyroidism, renal failure and macroprolactinemia.
- 3Repeat a fasting morning total testosterone on a separate day.Endocrine Society 2018; AUA 2018.
Missing information
- LH and FSH (to separate primary from secondary hypogonadism).
- SHBG (for calculated free testosterone).
Evidence and rule trace · 4 rules
HG-02One low testosterone result, not yet confirmed
Inputs: total testosterone 90 ng/dL · second sample not entered
Low total testosterone on a single sample: confirmation is required.
HG-MISS-01Information needed to classify
Inputs: low testosterone · LH missing
Type of hypogonadism cannot be classified without gonadotropins and prolactin.
HG-07Hyperprolactinemia with low testosterone
Inputs: prolactin 310 ng/mL (upper limit 20) · low testosterone
Raised prolactin with low testosterone.
HG-SAFE-01Possible pituitary mass effect
Inputs: severe or new headache, or visual field loss · low testosterone
Urgent assessment: possible pituitary mass effect.
Evidence
- EV-ES-TRT-2018 · Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
- EV-AUA-2018 · Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423-432.
- EV-ES-PRL-2011 · Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011;96(2):273-288.
Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and cautions. It does not diagnose, find the cause, or recommend starting, stopping or dosing testosterone therapy. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Against typical adult male reference intervals
Testosterone and hormones
- <264
- 264–299
- 300–350 borderline
- >350
4.3 g/dL is assumed when left empty.
Symptoms and findings
Possible reversible contributors
Testosterone therapy context
More testosterone cases
TESTO-FX-01
Low libido and erectile dysfunction, testosterone never measured
A 48-year-old with sexual symptoms and fatigue.
TESTO-FX-02
One low testosterone
Total testosterone 218 ng/dL on a single morning sample.
TESTO-FX-03
Low on two samples with a primary pattern
Testosterone 205 and 190 with LH 22 and FSH 31.
TESTO-FX-04
Secondary pattern with obesity and diabetes
LH 1.2 and FSH 2.0 with BMI 36.
TESTO-FX-05
Raised prolactin with low testosterone
Prolactin 95 ng/mL.
TESTO-FX-07
Borderline total testosterone
Total testosterone 320 with SHBG 62 and symptoms.
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