A 47-year-old man presented with persistent fatigue, vision loss, and low libido over the previous 2 months. He reported no headache, erectile dysfunction, breast tenderness or mass, arthralgias, edema, or increase in glove, ring, or shoe size. He was taking sertraline for treatment of anxiety disorder, and had a 15-year-old son. His examination was significant for the presence of bitemporal visual field defects on confrontation testing. He had no acromegalic features, gynecomastia, galactorrhea, or abnormal virilization. Testicular size was 20 mL for each. Laboratory tests were performed (Table), which revealed low serum testosterone and thyrotropin and elevated serum prolactin levels. A neuro-ophthalmic examination revealed the presence of symmetric superior temporal visual field defects on perimetry. Magnetic resonance imaging (MRI) was obtained to examine his brain.
Tritos NA, Klibanski A. Hyperprolactinemia. JAMA. 2015;314(16):1742-1743. doi:10.1001/jama.2015.7871