Texts: Case Study #3: Male Pituitary Adenoma Hoon-Ki is a 34-year-old man who visited a physician complaining of erectile dysfunction and sensitive growths on his breasts. The physician observed that Hoon-Ki appeared obese, and a test of his sperm count demonstrated oligospermia (low sperm count). Hoon-Ki said he had recovered from mumps a few years previously, and during that time had viral orchitis in one of his testicles. Further discussion revealed that Hoon-Ki was a heavy user of both marijuana and alcohol. Hoon-Ki did not have any chronic diseases and his musculature appeared normal. Examination revealed the presence of glandular masses in the breasts, indicating gynecomastia. The physician ordered blood tests for total testosterone, estradiol, LH, and prolactin, and asked that a karyotype be performed (observation of Hoon-Ki’s chromosomes) to test for Klinefelter’s syndrome. In the meantime, the physician strongly advised Hoon-Ki to cease using marijuana and alcohol. Hoon-Ki’s total plasma testosterone concentration was abnormally low, and his ratio of plasma estradiol to testosterone was abnormally high. Hoon-Ki’s plasma LH levels were low, and his prolactin levels were elevated. He did not have Klinefelter’s syndrome. The physician told Hoon-Ki that he could give him tamoxifen (a SERM that is an estrogen receptor antagonist in breast tissue) if his gynecomastia becomes painful, and said that he would give Hoon-Ki hCG injections for a time, then a preparation that also contains FSH activity, and then, once spermatogenesis was restored, he could be maintained on hCG. The physician also scheduled Hoon-Ki for an MRI, saying that he suspected that Hoon-Ki could have a pituitary adenoma. Questions (10 marks)

1. How is Hoon-Ki’s obesity related to his high ratio of plasma estradiol to testosterone? (2 marks)
2. How can chronic heavy use of marijuana and/or alcohol affect testosterone levels? (1 mark)
3. What is Klinefelter’s syndrome, and how would it affect the male reproductive system? (2 marks)
4. What findings from the clinical tests best explain Hoon-Ki’s gynecomastia? (1 mark)
5. Given that Hoon-Ki’s plasma LH levels were low, what might that indicate about the cause of Hoon-Ki’s symptoms? (2 marks)
6. How could hCG help alleviate Hoon-Ki’s low plasma testosterone levels and influence sperm production? (2 marks)

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