47 years old man, presented with chronic loose stool although normal frequency for 1 year duration. He also claiming to have abdominal bloatedness and early satiety each time taking meal. He had undergone endoscopic examination and did not found any organic pathology surrounding its GIT. He is a diabetic for >10 years and on T.Galvus-Met, Amaryl, Coozar, Lympathyl apart form taking his routine supplement ( Pharmaton Caplet).
A chronic smoker for >25 years with 15-20 stick per day. Claim to have loss of libido for the past 6 month and difficulty in waking up in the morning. Now he had dizzy spells especially when he feels bloated.
Examination shows he is well built, wt 83 and ht 1.78m. BMI 26kg/m2. BP normal. RBS 6.8mmol/dl. Other systemic review does not reveal any significant findings.
Hormonal assay result were as follows
IGF-1 = 214 ng/dl
TSH = 0.650 mIU/L
FT3 = 290 pg/dl
FT4 = 1.4 ng/dl
Cortisol = 18 mcg/dl
SHBG = 27 nmol/dl
DHEA-S = 156 mcg/dl
FSH = 5 mIU/ml
LH = 5 mIU/ml
Progesterone = 0.6 ng/dl
Total Testosterone = 545 ng/dl
Looking at this result, it shows that this man is having suboptimum IGF-1, TSH, DHEA-S, Progesterone and Testosterone...
As he is diabetic as well, what is the best recomended approach to this case...
Thanks
