title: Nonfunctioning pituitary macroadenoma: a case report from the patient perspective.
abstract: BACKGROUND
  Nonfunctioning pituitary macroadenoma (NFPA) is a tumour of the endocrine system that is virtually always benign and can be difficult to detect. This case report is presented from the patient's perspective to highlight experiences that led to the eventual diagnosis of this condition.
  
  
  METHODS
  A 48 year-old male experienced prolonged and unexplained reduced athletic performance worsening over five years. The patient reported decreased libido, which initiated a testosterone blood test. This confirmed reduced testosterone levels and resulted in an endocrinology referral. A subsequent dynamic contrast MRI of the pituitary region revealed a mass. The most frequent symptoms of NFPA are visual field defects, headaches and features of hypopituitarism (includes fatigue, dizziness, dry skin, irregular periods in women and sexual dysfunction in men).
  
  
  CONCLUSIONS
  Clinicians should consider this differential diagnosis in middle-aged athletes with diminished athletic performance from an unknown cause, test visual fields and inquire if symptoms of headaches or hypopituitarism are present.
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, ON Canada ; The Centre for Family Medicine Family Health Team, 25 Joseph Street, Kitchener, ON Canada N2G 4X6.
authors.forename: Craig A
authors.identifier: 0000-0002-5872-7101
authors.initials: CA
authors.lastname: Bauman
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, ON Canada ; The Centre for Family Medicine Family Health Team, 25 Joseph Street, Kitchener, ON Canada N2G 4X6.
authors.forename: James D
authors.initials: JD
authors.lastname: Milligan
authors.affiliation: School of Optometry and Vision Science, University of Waterloo, Waterloo, ON Canada.
authors.forename: Tammy
authors.initials: T
authors.lastname: Labreche
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, ON Canada ; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: Riva
keywords: Adenoma; Athletic; Macroadenoma; Middle-aged; Nonfunctioning; Performance; Pituitary