Rhoden Ernani Luis, Estrada Carlos, Levine Laurence, Morgentaler Abraham
Division of Urology, Beth Israel Deaconess Medical Center, Men's Health Boston, One Brookline Place, Suite 624, Brookline, MA 02445, USA.
J Urol. 2003 Sep;170(3):795-8. doi: 10.1097/01.ju.0000082960.84075.54.
We assessed the usefulness of magnetic resonance imaging (MRI) of the brain in the evaluation of hypogonadal men with a variety of endocrine patterns.
A total of 51 men with low levels of total testosterone (TT) or free testosterone (FT) underwent MRI. Erectile dysfunction and/or decreased libido were present in 43 (84.3%) of cases and infertility in 8 (15.7%). Serum prolactin (PRL) was obtained in all cases. Low levels of TT and FT were defined as less than 300 and 1.5 ng/dl, respectively. Markedly low levels of TT were defined as less than 200 ng/dl.
In 38 of 51 (74.5%) men the MRI was normal. A small pituitary gland (the partially empty sella syndrome) was noted in 9 (17.6%) cases and microadenoma was noted in 4 (7.8%). Prolactin levels were greater than twice the upper limit of normal in 3 of 4 (75%) cases of adenoma, and low FT was noted in all 4 cases. An additional case of adenoma was identified in a man with markedly decreased TT and normal PRL. All men with adenoma presented with the combination of erectile dysfunction and decreased libido. Among men without adenomas the highest PRL value was always less than twice the upper limit of normal. Overall, only 1 of 17 men with markedly decreased TT (less than 200 ng/dl) demonstrated adenoma. None of the 17 men with low luteinizing hormone with low TT or FT had an adenoma or pituitary/hypothalamic mass.
The likelihood of identifying pituitary adenoma by MRI is high if PRL levels are more than twice the upper limit of normal. Medically significant abnormalities are identified in only a small percentage of hypogonadal men with low luteinizing hormone or if TT levels are markedly decreased. The decision to obtain MRI in these latter cases should be based on individual circumstances.
我们评估了脑部磁共振成像（MRI）在评估具有多种内分泌模式的性腺功能减退男性中的作用。
共有51名总睾酮（TT）或游离睾酮（FT）水平较低的男性接受了MRI检查。43例（84.3%）存在勃起功能障碍和/或性欲减退，8例（15.7%）存在不育。所有病例均检测了血清催乳素（PRL）。TT和FT水平低分别定义为低于300 ng/dl和1.5 ng/dl。TT水平显著低定义为低于200 ng/dl。
51名男性中38名（74.5%）的MRI结果正常。9例（17.6%）发现垂体较小（部分空蝶鞍综合征），4例（7.8%）发现微腺瘤。4例腺瘤患者中有3例（75%）的催乳素水平高于正常上限的两倍，且所有4例均发现FT水平低。在一名TT显著降低但PRL正常的男性中发现了另外一例腺瘤。所有腺瘤患者均表现为勃起功能障碍和性欲减退。在无腺瘤的男性中，最高PRL值始终低于正常上限的两倍。总体而言，17名TT显著降低（低于200 ng/dl）的男性中只有1例显示有腺瘤。17名促黄体生成素低且TT或FT低的男性均无腺瘤或垂体/下丘脑肿块。
如果PRL水平高于正常上限的两倍，通过MRI识别垂体腺瘤的可能性很高。在性腺功能减退且促黄体生成素低或TT水平显著降低的男性中，仅一小部分会发现具有医学意义的异常。在这些情况下是否进行MRI检查应根据个体情况决定。
