List the symptoms (history and physical examination) that seem abnormal.

You are an endocrinologist. A 50- year old man came to your office. He reports to you 8 years of decreased libido, 4 years of chronic fatigue, cold intolerance, decreased beard growth, and poor tanning of the skin. He tells you that his shoe and ring size increased progressively over the past 20 years, along with increasing enlargement of his nose lips, tongue, and jaw. He also complained of retrobulbar headache (feeling a headache behind the eyes) with increasing severity.

After your examine him, you record a low blood pressure (100/65). His skin is dry and pale. Pubic and axillary (arm pits) hair were scanty. His testes were smaller in size compared to someone his age. The testes also felt softer. His blood test shows low plasma cortisol levels and low plasma testosterone levels.

Based on your understanding of basic endocrinology, you suspect hormonal problems. You posit that the problem lies in the anterior pituitary.

List the symptoms (history and physical examination) that seem abnormal. Collect them in groups, each of which seems to be associated with a single hormone system. Identify the hormone associated with each group and indicate whether the data suggest an increase or a decrease in hormone secretion rate.