Piccoli Giorgina B, Bermont Francesca, Magnano Andrea, Soragna Giorgio, Terzolo Massimo
Nephrology Unit, Department of Internal Medicine, University of Turin, Dialisi e Trapianto, Corso Bramante 88, 10126 Torino, Italy.
Rev Diabet Stud. 2006 Winter;3(4):200-4. doi: 10.1900/RDS.2006.3.200. Epub 2007 Feb 10.
Dialysis patients often suffer from erectile dysfunction. The prevalence of this symptom in the context of dialysis is as high as 90%. Diabetes, diffuse vascular disease and pharmacological therapy are attendant causes of this condition, severely impairing the quality of life. Due to the high frequency of erectile dysfunction in uremic patients, minimalist diagnostic approaches are often used. Nevertheless, a careful differential diagnosis is also warranted in well dialyzed patients to identify causes and corrigible patterns. The case reported here exemplifies this critical issue. A 44 year old obese diabetic patient complained about the recent onset of erectile dysfunction. On examination, the penile echo-Doppler was normal, and suggested a cause other than dia-betic vascular disease. The high dialysis efficiency (daily hemodialysis, flexible schedules, EKRc from 15 to 25 ml/min) warranted the same diagnostic work-up as would adopted for non-uremic patients. Whilst the rising prolactine level (76.1 microg/l and 129 ng/ml) was still in the range commonly found in dialysis patients, a nuclear magnetic resonance examination was carried out and led to the identification of prolactinoma. Therapy with cabergoline was found effective and sexual potency was restored. Normalization of hormonal patterns followed within 2 months. This is the first case so far reported in a daily dialysis patient. It underlines the importance of a non-minimalist approach to the problem of sexual disorders in renal replacement therapy (RRT) patients, at least when dialysis efficiency is high and onset is rapid. It also suggests considering prolactinoma as an emerging diagnosis in the general population, which can be detected by the use of sensitive imaging techniques in the differential diagnosis of this condition.
透析患者常患有勃起功能障碍。在透析背景下，这种症状的患病率高达90%。糖尿病、弥漫性血管疾病和药物治疗是导致这种情况的伴随原因，严重损害生活质量。由于尿毒症患者勃起功能障碍的发生率很高，因此常采用极简诊断方法。然而，对于透析良好的患者，也需要进行仔细的鉴别诊断，以确定病因和可纠正的模式。本文报道的病例例证了这一关键问题。一名44岁的肥胖糖尿病患者抱怨近期出现勃起功能障碍。检查时，阴茎超声多普勒检查正常，提示病因并非糖尿病血管疾病。高透析效率（每日血液透析、灵活的时间表、Kt/V从15至25ml/min）使得对该患者的诊断检查与非尿毒症患者相同。虽然催乳素水平升高（76.1μg/l和129ng/ml）仍在透析患者常见范围内，但进行了核磁共振检查，结果发现了催乳素瘤。发现使用卡麦角林治疗有效，性功能得以恢复。2个月内激素水平恢复正常。这是迄今为止报道的首例每日透析患者的此类病例。它强调了在肾替代治疗（RRT）患者中，对于性障碍问题采用非极简方法的重要性，至少在透析效率高且发病迅速时如此。它还表明，在普通人群中应考虑将催乳素瘤作为一种新出现的诊断，在这种疾病的鉴别诊断中可通过使用敏感的成像技术进行检测。
