A 52 years old man presents with some difficulty driving at night and reports not seeing cars coming from the sides. He also describes progressive loss of libido and inability to obtain and maintain an erection, which started about 2 years ago. He has gained about 5 kg (11 lbs) in weight over the 2 to 3 years and reports increased fatigue that makes him unable to do the same jobs that he used to do a year ago. On physical examination, the patient has a BMI 35 and abnormal visual fields with bitemporal hemianopia. What are the most important differential diagnoses?

Of the relevant differential diagnoses, it is important to rule out parasellar tumors, pituitary hyperplasia, meningioma and vascular aneurysm.

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This post was written by Omar Rifai