Retain
- Loss of libido and erection disorders generally affect elderly men.
- However, young men can also be concerned, as shown in the clinical case of a patient described by the Dr Kai-Philipp lens and the Dr Martin Hartmann (Department of Dermatology, Venereology and Allergology, Heidelberg University Hospital Center) in an article recently published in a specialized review.
The patient and his history
According to the authors, this 26 -year -old man appeared at the consultation due to a loss of libido and an erectile dysfunction for several months. In addition, according to him, his ejaculatory volume and his testosterone level had decreased. He answered in the negative to the question of whether he took a long -term drug treatment.
Results and diagnosis
- Physical and neurological examination without particularity, no sign of gynecomastia, galactorrhea or reduction in testicular volume.
- Diagnosis of ejaculat: reduced volume (0.6 ml, reference ≥ 1.4 ml), sperm concentration 201 million/ml (reference ≥ 16 million/ml).
- A control spermogram after 6 weeks confirmed the initial results.
- Hormonal diagnosis: high prolactin level (555 MU/L, reference 43-375 MU/L), reduced luteinizing hormone level (0.6 U/L, reference 1.5-9.3 U/L), low folliculo-stimulant hormone level (FSH) 1.5 U/L (reference 0.9-15.0 U/L) and rate of reduced testosterone (0.555 NG/ML, reference 2-7 ng/ml).
- Confirmation of these results after 6 weeks.
- Cranial MRI: Lesion of approximately 2 × 2 mm in the paralty right adenohypophysis.
- Diagnosis: prolactinomic microadenoma of pituitary gland (prolactinoma) with secondary hypogonadodo hypogonadism.
Discussion
Due to the general availability and the improvement of the MRI technique, the authors of a article on pituitary adenomas have reported an increase in the number of pituitary masses detected in recent decades. Brain MRI examinations have revealed fortuitous pituitary adenomas in 10 to 40 % of cases, compared to 5 to 20 % of brain computed tomography. In studies post-mortempituitary adenomas have been observed in around 10 % of cases, mainly microadenomas. About 85 % of incident tumors would be primary pituitary adenomas. Some of them have an excess hormonal. Among hormone-active adenomas, prolactinomas are the most frequent (around 75 %), followed by adenomas producing growth hormone (approximately 15 %) or adrenocorticotropic hormone (around 8 %); The adenomas producing the thyreostimulant hormone are rare (approximately 2 %). Hypophyseal adenomas are classified as microadenomas (<10 mm) and macroadenomas (≥ 10 mm).
According to Kai-Philipp Linse and Martin Hartmann doctors, hyperprolactinemia leads to loss of libido, erection disorders, osteoporosis, gynecomastia and reduced spermatogenesis that can go as far as infertility. Macroadenomas can also cause headache and losses of the visual field due to compression of the chiasma.
The basal measurement of the serum prolactin concentration is enough to detect a prolactinoma. The size of the adenoma is in positive correlation with the concentration of prolactin. Values> 200 ng/ml (reference range <20 ng/ml) indicate a high probability of prolactinoma. In case of light hyperprolactinemia (<200 ng/ml), other causes of hyperprolactinemia must be envisaged, such as:
- pregnancy,
- the compression or deformation of the pituitary pedicle, for example, by a pituitary tumor of other etiology,
- kidney failure,
- hypothyroidism,
- Medicines, such as psychotropic drugs, metoclopramide, verapamil or opiates,
- cannabis consumption,
- In addition, hypothyroidism and renal failure can be accompanied by an increase in prolactin rates. It is also necessary to systematically exclude any physical effort, stress or technical disorder linked to the dosage.
Treatment and evolution
The objective of processing a prolactinoma is to restore the function of the genital glands and control the tumor mass, explain the Kai-Philipp Linse and Martin Hartmann doctors. Given that only a small part of the microprolalactinomas tends to grow, the treatment generally aims to preserve the gonadic function. Privileged treatment is a dopamine agonist therapy. Cabergoline, quinagolide or bromocriptine treatment generally leads to a correct therapeutic response with normalization of prolactin levels, reduction in tumor size and preservation of gonadic function. In the event of an insufficient response to the drug treatment or unwanted symptoms pronounced, surgery or radiotherapy may be envisaged.
This article has been translated fromUnivadis.de. The content was reviewed by the editorial staff before publication.