Citron J T, Ettinger B, Rubinoff H, Ettinger V M, Minkoff J, Hom F, Kan P, Alloo R
Department of Medicine, Kaiser Permanente Medical Centers, Walnut Creek, California 94596-5300, USA.
J Urol. 1996 Feb;155(2):529-33.
Because prevalence of structural lesions of the pituitary and hypothalamus in impotent men with secondary hypogonadism was undefined, we evaluated 164 men 27 to 79 years old whose chief complaint was erectile dysfunction and who repeatedly had low serum testosterone levels (less than 230 ng./dl.).
With computerized tomography or magnetic resonance imaging of the sella we detected potentially serious lesions (pituitary lesions greater than 5 mm. or any hypothalamic lesion) in 11 men (6.7%, 95% confidence interval 2.9 to 10.5%), including 5 pituitary microadenomas (5 mm. or larger), 4 pituitary macroadenomas and 2 hypothalamic lesions.
Mean serum testosterone was lower in patients with (121 +/- 66 ng./dl., standard deviation) than without (177 +/- 39 ng./dl.) hypothalamic or pituitary imaging abnormalities (p < 0.001). For every 10 ng./dl. decrease in testosterone the risk of hypothalamic or pituitary imaging abnormalities increased 1.2-fold (p < 0.005). Macroadenomas and hypothalamic lesions were confined to 6 subjects with testosterone levels of 104 ng./dl. or less.
The risk of hypothalamic or pituitary imaging abnormalities is low among men evaluated for erectile dysfunction and secondary hypogonadism. However, this risk increases markedly when the serum testosterone level is markedly decreased.
由于继发性性腺功能减退的阳痿男性垂体和下丘脑结构病变的患病率尚不明确，我们评估了164名年龄在27至79岁之间、主要诉求为勃起功能障碍且血清睾酮水平反复偏低（低于230 ng./dl.）的男性。
通过蝶鞍的计算机断层扫描或磁共振成像，我们在11名男性（6.7%，95%置信区间为2.9%至10.5%）中检测到潜在的严重病变（垂体病变大于5 mm或任何下丘脑病变），其中包括5例垂体微腺瘤（5 mm或更大）、4例垂体大腺瘤和2例下丘脑病变。
下丘脑或垂体成像异常的患者平均血清睾酮水平（121±66 ng./dl.，标准差）低于无异常者（177±39 ng./dl.）（p<0.001）。睾酮每降低10 ng./dl.，下丘脑或垂体成像异常的风险增加1.2倍（p<0.005）。大腺瘤和下丘脑病变局限于6名睾酮水平为104 ng./dl.或更低的受试者。
在因勃起功能障碍和继发性性腺功能减退接受评估的男性中，下丘脑或垂体成像异常的风险较低。然而，当血清睾酮水平显著降低时，这种风险会显著增加。
