Andereggen Lukas, Tortora Angelo, Schubert Gerrit A, Musahl Christian, Frey Janine, Stieger Andrea, Kobel Béatrice, Luedi Markus M, Roethlisberger Michel, Mariani Luigi, Beck Jürgen, Christ Emanuel
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
Faculty of Medicine, University of Bern, Bern, Switzerland.
Acta Neurochir (Wien). 2024 Jul 31;166(1):314. doi: 10.1007/s00701-024-06213-9.
Erectile dysfunction (ED) is frequently underreported in men suffering from prolactinomas and can be challenging to manage. Both dopamine agonists (DAs) and transsphenoidal surgery (TSS) correct hyperprolactinemia and restore gonadal function. However, there is scarce data regarding their effectiveness in correcting ED over the long term.
This study is a retrospective single-center comparative cohort study analyzing men diagnosed with prolactinomas, both with and without confirmed erectile dysfunction (ED) at diagnosis. Independent risk factors for persistent ED over the long term were examined using multivariate logistic regression.
Among the 39 men with lactotroph adenomas, ED was one of the presenting symptoms in 22 (56%). The mean age at diagnosis was 45 ± 12 years. Surgery was the primary treatment in 6 (27%) ED patients and 8 (47%) non-ED patients. After a mean follow-up of 74 ± 48 months, remission from hyperprolactinemia was achieved in the majority (76%) of men: 71% in the non-ED cohort and 81% in the ED group (p = 0.70), regardless of the primary treatment strategy (surgical 84% versus medical 72%, p = 0.46). Long-term remission of ED was noted in 16 (73%) patients. Interestingly, high baseline BMI levels emerged as potential risk factors for persistent ED over the long term (OR 1.4, 95%CI 1.0-1.9; p = 0.04), while neither the initial adenoma size nor the primary treatment strategy (i.e., TSS vs. DAs) reached statistical significance.
Correcting hyperprolactinemia and its associated hypogonadism significantly improves ED in the majority of men with prolactinomas over the long term, regardless of the primary treatment strategy employed. In addition to addressing endocrine deficiencies, the early initiation of weight control programs may be considered for men with lactotroph adenomas and ED. Although our study suggests an association between BMI and the risk of persistent ED, further research is needed to establish any causal relationships.
勃起功能障碍（ED）在患有泌乳素瘤的男性中经常未得到充分报告，且管理起来可能具有挑战性。多巴胺激动剂（DAs）和经蝶窦手术（TSS）均可纠正高泌乳素血症并恢复性腺功能。然而，关于它们长期纠正ED有效性的数据很少。
本研究是一项回顾性单中心比较队列研究，分析诊断为泌乳素瘤的男性，诊断时有无确诊勃起功能障碍（ED）。使用多因素逻辑回归分析长期持续性ED的独立危险因素。
在39例催乳素瘤男性中，ED是22例（56%）的首发症状之一。诊断时的平均年龄为45±12岁。手术是6例（27%）ED患者和8例（47%）非ED患者的主要治疗方法。平均随访74±48个月后，大多数男性（76%）实现了高泌乳素血症缓解：非ED队列中为71%，ED组中为81%（p = 0.70），无论主要治疗策略如何（手术84%对药物治疗72%，p = 0.46）。16例（73%）患者的ED得到长期缓解。有趣的是，高基线BMI水平成为长期持续性ED的潜在危险因素（OR 1.4，95%CI 1.0 - 1.9；p = 0.04），而初始腺瘤大小和主要治疗策略（即TSS与DAs）均未达到统计学意义。
无论采用何种主要治疗策略，纠正高泌乳素血症及其相关的性腺功能减退在大多数患有泌乳素瘤的男性中长期而言均可显著改善ED。除了纠正内分泌缺陷外，对于患有催乳素瘤和ED的男性，可考虑早期启动体重控制计划。尽管我们的研究表明BMI与持续性ED风险之间存在关联，但需要进一步研究以确定任何因果关系。
