Endocrinology Question 58

A 34-year-old man is evaluated for a 2-year history of fatigue, low libido, and infertility. His family history is notable for a brother with infertility. His medical history is unremarkable, and he takes no medications.

On physical examination, vital signs are normal. His height is 195.6 cm (77 in), and his weight is 86.2 kg (190 lb). Genital examination reveals small, firm testes bilaterally.

Laboratory studies reveal a morning serum total testosterone level of 140 ng/dL (4.9 nmol/L) (which was confirmed on repeat testing), a serum follicle-stimulating hormone level of 24 mU/mL (24 U/L), and a serum luteinizing hormone level of 18 mU/mL (18 U/L). Repeated semen analyses reveal azoospermia.

Which of the following is the most appropriate diagnostic test to perform next?

A  Karyotype

B  MRI of the pituitary

C  Scrotal ultrasound

Serum prolactin measurement

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