Carlier Lea, Chanson Philippe, Cazabat Laure, Daclin Sylvie, Salenave Sylvie, Hage Mirella, Trabado Séverine, Young Jacques, Maione Luigi
Department of Endocrinology and Reproductive Diseases, Université Paris-Saclay, Inserm UMRS1185, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, 94275 Le Kremlin-Bicêtre, France.
Department of Endocrinology, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100 Boulogne Billancourt, France.
J Endocr Soc. 2024 Jul 16;8(9):bvae135. doi: 10.1210/jendso/bvae135. eCollection 2024 Jul 26.
Testosterone concentrations, albeit rarely, may be in the normal range (>3.0 ng/mL) in men with a prolactin-secreting pituitary adenoma (PSPA-nt). The evolution of total, bioavailable testosterone, gonadotropin levels, and that of graded symptoms of testosterone deficiency (TD) are uncertain in these patients.
Retrospective case-control longitudinal study at a tertiary referral center.
From 287 men, we selected 25 PSPA-nt men undergoing prolactin normalization (<20.0 ng/mL) during the follow-up. Graded symptoms of TD were investigated by structured interviews. Biochemical changes and TD symptoms were compared to those of a matched cohort of 61 men with pituitary neoplasms and normal testosterone levels (PA-nt).
Baseline testosterone levels were similar between PSPA-nt and PA-nt subjects. The prevalence of specific and suggestive symptoms of TD was higher in PSPA-nt (20% and 68%) than in PAnt (3.3 and 29.5%; = .02 and = .0015, respectively). At the follow-up, total and bioavailable testosterone levels increased in PSPA-nt but not in PA-nt patients (Δ change: 1.28 ± 2.1 vs0.03 ± 1.5 ng/mL, + 0.33 ± 0.55 vs-0.26 ± 0.60 ng/mL; = .0028 and = .0088, respectively). LH and FSH levels also increased in PSPA-nt men ( < .05). Specific and suggestive, but not nonspecific symptoms of TD, improved only in PSPA-nt men ( < .05 for both). Baseline testosterone and LH were the strongest predictors of testosterone improvement in PSPA-nt patients.
Despite having normal testosterone levels at baseline, patients with PSPA-nt experience a relief of TD symptoms and an improvement of their pituitary-gonadal axis function following prolactin normalization, especially when baseline TT and LH levels are in the low-normal range.
分泌催乳素的垂体腺瘤男性患者（PSPA - nt）的睾酮浓度虽很少处于正常范围（>3.0 ng/mL）。这些患者中总睾酮、生物可利用睾酮、促性腺激素水平的变化以及睾酮缺乏（TD）分级症状的变化尚不确定。
在一家三级转诊中心进行的回顾性病例对照纵向研究。
从287名男性中，我们选取了25名在随访期间催乳素恢复正常（<20.0 ng/mL）的PSPA - nt男性。通过结构化访谈调查TD分级症状。将生化变化和TD症状与61名垂体肿瘤且睾酮水平正常的男性（PA - nt）匹配队列进行比较。
PSPA - nt和PA - nt受试者的基线睾酮水平相似。PSPA - nt中TD的特定及提示性症状患病率高于PA - nt（分别为20%和68% 比3.3%和29.5%；P分别为0.02和0.0015）。在随访时，PSPA - nt患者的总睾酮和生物可利用睾酮水平升高，而PA - nt患者未升高（变化差值：1.28±2.1比0.03±1.5 ng/mL，+0.33±0.55比 - 0.26±0.60 ng/mL；P分别为0.0028和0.0088）。PSPA - nt男性的促黄体生成素（LH）和促卵泡生成素（FSH）水平也升高（P<0.05）。仅PSPA - nt男性的TD特定及提示性症状而非非特异性症状有所改善（两者P<0.05）。基线睾酮和LH是PSPA - nt患者睾酮改善的最强预测因素。
尽管PSPA - nt患者基线睾酮水平正常，但在催乳素恢复正常后，尤其是当基线总睾酮（TT）和LH水平处于低正常范围时，他们的TD症状得到缓解，垂体 - 性腺轴功能得到改善。
