Clinical Reasoning: Accumulating endocrinopathies in a car salesman.

A 65-year-old man working as a car dealer was referred to our neurology outpatient clinic because of a pituitary mass. Two years before referral, the patient had developed symptoms of polyuria and polydipsia, decreased endurance while working out, fatigue, loss of body hair, and erectile dysfunction. The endocrinologist found hypogonadotropic hypogonadism, hypocortisolism, and central diabetes insipidus, which was treated with testosterone, hydrocortisone, and desmopressin, resulting in adequate control of his symptoms. He did not report symptoms of headache, decreased vision, or neurologic deficits. An MRI of the pituitary gland was performed and showed an enlarged gland and stalk with gadolinium enhancement (figure 1).