Colao A, De Rosa M, Sarnacchiaro F, Di Sarno A, Landi M L, Iervolino E, Zarrilli S, Merola B, Lombardi G
Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy.
Eur J Endocrinol. 1996 Nov;135(5):548-52. doi: 10.1530/eje.0.1350548.
The aim of this study was to evaluate the effects of a chronic treatment with the non-ergot-derived dopamine agonist quinagolide (CV 205-502) on sexual and gonadal function in hyperprolactinemic males. Thirteen males with macroprolactinoma and one with microprolactinoma were treated with CV 205-502 at the dose of 0.15-0.6 mg/day for 6-24 months. Baseline prolactin (PRL) was 464 +/- 75.7 microg/l. All the patients suffered from libido impairment, five of reduced sexual potency, six had infertility and in four bilateral induced galactorrhea was shown. The semen analysis revealed a severe oligoasthenospermia with reduced sperm count, motility and forward progression, with an abnormal morphology and decreased viability. A significant reduction of serum PRL levels (nadir PRL = 12.3 +/- 5.4 microg/l) was obtained during the treatment. Normalization of prolactinemia was reached in 13 of the 14 patients after 3 months. After 1 year, a significant improvement of sperm parameters, in terms of increase of number (from 5600 +/- 111 to 20,564 +/- 587 mm3), motility at 1 h (from 24.8 +/- 0.1 to 52.6 +/- 0.5%), forward progression (from 24 +/- 1.4 to 62.3 +/- 2.9%) and normal morphology (from 53.8 +/- 2.5 to 62.2 +/- 2.4%), was recorded. In addition, a significant increase of serum follicle-stimulating hormone (from 5.3 +/- 0.6 to 7.8 +/- 0.4 U/l), luteinizing hormone (from 4.4 +/- 0.5 to 7.7 +/- 0.4 U/l) and testosterone (from 3.4 +/- 0.4 to 4.7 +/- 0.2 microg/l) was recorded. A significant increase of luteinizing hormone (9.4 +/- 0.7 U/l) and testosterone (5.2 +/- 0.4 microg/l), as well as a further improvement of sperm parameters, was found after 2 years of therapy. Sellar computed tomography and/or magnetic resonance showed a considerable shrinkage (> or = 30%) of tumoral mass in 8 out of 13 patients with macroprolacinoma. Side effects were recorded in only one patient. In conclusion, the treatment with CV 205-502 normalizing PRL levels improves gonadal and sexual function and fertility in males with prolactinoma, providing good tolerability and excellent patient compliance to medical treatment. This result demonstrates that the impairment of gonadal function in hyperprolactinemic patients is a functional modification.
本研究的目的是评估用非麦角衍生的多巴胺激动剂喹高利特（CV 205-502）长期治疗对高泌乳素血症男性的性功能和性腺功能的影响。13例大泌乳素瘤男性患者和1例微泌乳素瘤男性患者接受了CV 205-502治疗，剂量为0.15 - 0.6毫克/天，治疗时间为6 - 24个月。基线泌乳素（PRL）为464±75.7微克/升。所有患者均有性欲减退，5例性功能减退，6例不育，4例有双侧诱发性溢乳。精液分析显示严重少弱精子症，精子数量、活力和前向运动能力降低，形态异常且活力下降。治疗期间血清PRL水平显著降低（最低PRL = 12.3±5.4微克/升）。14例患者中有13例在3个月后泌乳素血症恢复正常。1年后，精子参数有显著改善，数量增加（从5600±111至20,564±587立方毫米），1小时活力（从24.8±0.1至52.6±0.5%）,前向运动能力（从24±1.4至62.3±2.9%）以及正常形态（从53.8±2.5至62.2±2.4%）。此外，血清促卵泡生成素（从5.3±0.6至7.8±0.4 U/L）、黄体生成素（从4.4±0.5至7.7±0.4 U/L）和睾酮（从3.4±0.4至4.7±0.2微克/升）显著增加。治疗2年后，黄体生成素（9.4±0.7 U/L）和睾酮（5.2±0.4微克/升）显著增加，精子参数进一步改善。13例大泌乳素瘤患者中有8例蝶鞍计算机断层扫描和/或磁共振显示肿瘤体积显著缩小（≥30%）。仅1例患者记录到有副作用。总之，用CV 205-502治疗使PRL水平正常化可改善泌乳素瘤男性患者的性腺功能、性功能和生育能力，耐受性良好且患者对药物治疗的依从性极佳。这一结果表明高泌乳素血症患者的性腺功能损害是一种功能性改变。
