A case of a 26-year-old man reveals how prolactinomas disrupt hormones, causing libido loss and erectile dysfunction.
Loss of libido and erectile dysfunction are typically associated with older men, but younger men can also be affected, as illustrated by the described by Kai-Philipp Linse, MD, and Martin Hartmann, MD, from the Department of Dermatology, Venereology and Allergology at Heidelberg University Hospital in Heidelberg, Germany.
A 26-year-old patient reported several months of loss of libido and ED. He also noted reduced ejaculate volume and testosterone levels. He denied taking any long-term medications.Physical and neurologic examinations were unremarkable, with no signs of gynaecomastia, galactorrhoea, or reduced testicular volume. Repeat semen analysis after 6 weeks confirmed the initial findings, showing reduced ejaculate volume and a sperm concentration of 201 million/mL . Hormonal analysis showed elevated prolactin levels , low luteinizing hormone levels , low follicle-stimulating hormone levels , and reduced testosterone levels . The findings were consistent across repeated assessments after 6 weeks. Cranial MRI revealed a 2 mm × 2 mm contrast-enhancing lesion in the right paramedian region of the adenohypophysis. Prolactin-producing pituitary microadenoma with secondary hypogonadotropic hypogonadism was confirmed.in recent decades. Pituitary incidentalomas are found in 10%-40% of cerebral MRIs and 5%-20% of cranial CT scans. Autopsies have shown pituitary adenomas in approximately 10% of cases, most of which are microadenomas. Approximately 85% of incidentalomas are primary pituitary adenomas, some of which produce excess hormones. Among hormone-active adenomas, prolactinomas are the most common , followed by adrenocorticotropic hormone–producing adenomas , growth hormone–producing adenomas , and thyroid hormone–producing adenomas.Hyperprolactinaemia can cause libido loss, ED, osteoporosis, gynaecomastia, and impaired spermatogenesis, potentially resulting in infertility. Macroadenomas can also cause headaches and visual field defects due to compression of the optic chiasm. According to the authors, measurement of basal serum prolactin levels is sufficient to confirm prolactinoma. Serum prolactin levels generally correlate with tumour size. Prolactin levels >200 ng/mL are strongly indicative of prolactinoma. For mild hyperprolactinaemia , alternative aetiologies must be considered, including:Compression or distortion of the pituitary stalk, for instance due to a non–prolactin-secreting pituitary tumourCannabis use Hypothyroidism and renal insufficiency are associated with elevated prolactin levels. Physical exertion, stress, and assay interference should also be excluded. The treatment goal for prolactinomas is to restore gonadal function and control tumour growth, as explained by Linse and Hartmann. Because only a small proportion of microprolactinomas grow, gonadal function preservation is usually the primary focus of treatment for patients with prolactinomas. Dopamine agonists are the preferred treatment. Medications such as cabergoline, quinagolide, and bromocriptine typically normalise prolactin levels, reduce tumour size, and restore gonadal function. In cases of inadequate response to medical treatment or significant side effects, surgery or radiotherapy may be considered as treatment options.
Impotence Erectile Dysfunction (ED) Prolactinoma Magnetic Resonance Imaging Magnetic Resonance Imaging (MRI) UK Site Content United Kingdom Site Content United Kingdom UK Pituitary Pituitary Adenoma Adenoma Of The Pituitary Pituitary Microadenoma Neuroendocrine Tumor Neuroendocrine Tumour NET Nets Neuroendocrine Tumor (NET) Neuroendocrine Tumors (Nets)
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