Hyperprolactinémie et fonction sexuelle chez l’homme

Erectile dysfunction (ED), generally associated with reduced sexual desire and sometimes with orgasmic or ejaculatory dysfunction, is the major presenting symptom of hyperprolactinemia (HPRL) in men, a condition which should not be missed since many cases are due to pituitary tumors, likely to result in serious complications. It is generally believed that the mechanism of prolactin (PRL)-induced sexual dysfunction is a decrease in testosterone secretion. In fact, serum testosterone is normal in many hyperprolactinemic males and testosterone-independent mechanisms are also involved, probably mainly involving cerebral neurotransmitter systems. Systematic determinations of serum PRL have found very low prevalences of marked HPRL (>35 ng/ml) in ED patients (0.76% in a compilation of more than 3,200 patients) and pituitary adenoma (0.4%). In addition, the association of HPRL with ED may have been coincidental in some of these cases, since 10% of HPRLs diagnosed by the usual immunological assays are due to macroprolactins, which are biologically inactive or minimally active variants of PRL. Specific identification of PRL requires PRL chromatography which is only available in some specialized laboratories. No consensus has yet been reached concerning screening for HPRL in ED. Systematic determination of serum PRL may be justified, as HPRL is a serious but reversible disease, while there is presently no reliable clinical, psychometric or hormonal criteria (including serum testosterone level) allowing to restrict its determination to certain categories of ED patients without a risk of missing certain cases of HPRL. In the case of consistent HPRL, looking for hypothalamic or pituitary tumor is mandatory. Dopamine-agonist therapy is the first-line treatment for PRL-induced sexual dysfunction. Sexual counselling may be necessary for some patients.     

Reversal of sexual impotence in male patients with chronic obstructive pulmonary disease and hypoxemia with long term oxygen therapy

Erectile impotence is commonly encountered in male patients with respiratory failure and hypoxia. In this study, 42% of the patients experienced reversal of sexual impotence during long term oxygen therapy (LTOT). We examine the association between sexual impotence, gonadal axis hormones, hypoxia, and oxygen therapy. Nineteen sexually impotent male patients eligible for LTOT (pO₂ < 7.3 kPa during stable disease) and with sexual impotence received oxygen therapy for 1 month (n = 12) or 24 h (n = 7). pO₂, LH, FSH, testosterone, and SHBG (sex hormone binding globulin) were monitored. Five of 12 patients receiving oxygen for 1 month regained sexual potency. The responders showed a significant increase in arterial pO₂ and serum testosterone, and a decline in SHBG compared to non-responders. None of the patients receiving oxygen for 24 h experienced reversal of sexual impotence, despite a significant increase in pO₂. In these patients, serum testosterone did not increase significantly. Reversal of sexual impotence may be achieved in some patients with respiratory failure. The oxygen therapy must, however be administered for an adequate length of time.     

Hypothalamo-hypophyseo-gonadal axis in individuals with chronic renal insufficiency subjected to hemodialysis

The role of pituitary and sexual hormones in 21 patients with chronic renal failure (CRF) and related impotence and loss of libido who were being treated by hemodialysis and in 15 normal male controls has been studied. In both groups the serum levels of FSH, LH and TSH, PRL before and after injection of both LHRH and TRH were measured as well as the basal levels of Testosterone (T) and Estradiol (E2). The results show similar values for testosterone in both groups and statistically significant higher basal values for FSH, LH, TSH and PRL and lower basal values for E2 in CRF patients.     

Prolactin secretion in patients with idiopathic diabetes insipidus.

It has been demonstrated that hyperprolactinemia is sometimes present even in patients with idiopathic diabetes insipidus (DI). In this study, we examined the responses of serum prolactin (PRL) to hypertonic saline infusion and TRH injection in 11 patients with idiopathic DI diagnosed by clinical examinations. Serum sodium in these patients (147.5 +/- 3.2 mEq/L) was significantly higher at baseline than in normal subjects (139.7 +/- 2.4 mEq/L). The plasma arginine vasopressin (AVP) level was significantly lower in DI (0.42 +/- 0.24 pg/ml) at baseline than in normal subjects (2.53 +/- 1.03 pg/ml). However, the serum PRL level in both groups did not differ significantly except in one patient with idiopathic DI (35.6 ng/ml). There was no significant correlation between the basal serum sodium and basal serum PRL in either group. After an infusion of hypertonic saline, the serum sodium level gradually increased to 155.6 +/- 3.4 mEq/L in DI and to 146.5 +/- 4.3 mEq/L in the normal subjects. However, this increase did not affect PRL secretion in either group. PRL response to TRH was essentially normal in all patients with idiopathic DI. These results indicate that the secretion of PRL is not generally affected by chronic mild hypernatremic hypovolemia in the patients with idiopathic DI.     

Sexual behavior and serum concentrations of reproductive hormones in normal stallions

Recently, it has been reported that impotence in the stallion has a physiological basis that involves decreased serum concentrations of luteinizing hormone (LH) and estradiol-17beta, but not testosterone. We have found such a hormonal profile in two of nine stallions studied during an ongoing investigation of the endocrinology of the normal stallion. Nevertheless, both of these stallions possessed vigorous libido and normal seminal characteristics. We conclude that the hormonal profile of low LH, low estradiol and normal testosterone, although it may accompany impotence in the stallion, is not predictive of, or causally related to, abnormalities in sexual behavior.     

A case of histiocytosis X associated with panhypopituitarism and hyperimmunoglobulinemia G and E.

A 43 year old man with diabetes insipidus who showed panhypopituitarism and marked hypergammaglobulinemia due to histiocytosis X is reported. His low basal plasma adrenocorticotropin (ACTH) and growth hormone (GH) failed to respond to insulin-induced hypoglycemia. His basal serum thyroid hormone level was below normal and normal basal plasma thyrotropin (TSH) showed a delayed response with normal peak value to TSH-releasing hormone (TRH). Normal basal plasma pituitary gonadotropin also showed a delayed response with normal peak value to luteinizing hormone-releasing hormone (LH-RH). Suppression of plasma prolactin (PRL) by levodopa (l-dopa) was impaired and elevation of basal plasma PRL was noted at the second admission. These results, combined with diabetes insipidus, suggested that the panhypopituitarism in these patients was hypothalamic in origin. The polyclonal hypergammaglobulinemia was characterized by elevated serum IgG and IgE levels which returned to normal after corticosteroid treatment with concomitant clinical improvement. Elevated serum IgE levels, tissue and peripheral eosinophilia, and the effectiveness of corticosteroid therapy support the hypothesis that some allergic mechanism may be involved in the pathogenesis of this disease.     

Sexual behavior and serum concentrations of reproductive hormones in impotent stallions

In an attempt to ascertain the cause of abnormal sexual behavior, serum concentrations of hormones were examined in normal (n=7) and impotent (n=7) stallions. Normal stallions achieved an erection (63 ± 19 sec) when exposed to a teaser mare, and mounted (17 ± 6 sec) and ejaculated (38 ± 5 sec) upon subsequent exposure to an estrous mare. In general, impotent stallions did not achieve an erection, mount or ejaculate. Serum concentrations of testosterone in normal and impotent stallions were similar; however, concentrations of luteinizing hormone (LH) were lower (P < 0.05) in impotent than in normal stallions. Further, the serum concentrations of estradiol-17β in impotent stallions were also lower (P < 0.05) than those in normal stallions. Apparently, there is a physiological basis for impotence in stallions involving decreased serum concentrations of LH and estradiol, but not testosterone; however, whether the reduced concentrations of LH and estradiol occur prior to, or result from, behaviorial impotence is not clear.     

Endocrine aspects of sexual mimicry in Spotted hyaenas Crocuta crocuta

Female Spotted hyaenas mimic the male in the possession of a peniform and highly erectile clitoris and false scrotum. Sex hormones have been assayed in the blood plasma, gonads and adrenal glands of male and female Spotted hyaenas and in the blood plasma of Striped and Brown hyaenas. Although the testicular concentration of testosterone greatly exceeds that of the ovaries in Spotted hyaenas, there is no significant difference between the sexes in the mean plasma levels of this hormone, or of the other androgen assayed, andro-stenedione. In contrast, male Brown and Striped hyaenas have far higher plasma concentrations of testosterone than females.
Testosterone levels in twin female Spotted hyaena foetuses were similar to the mean for adult females and it is suggested that high foetal androgen levels are responsible for the appearance of the male sexual facies in adult female Spotted hyaenas. The high plasma androgen levels recorded in adult females may also be associated with their aggression and dominance of males.     

Effects of renovascular hypertension on reproductive function in male rats

OBJECTIVE: The present study investigated the effects of renovascular hypertension (2K/1C model) on the reproductive function of male rats, represented by sexual behavior, plasma prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone, and spermatogenesis. METHODS: The present experiments were performed to investigate the reproductive function of 2K/1C male Wistar rats and compare with 2K/1C male rats successfully treated for hypertension with nifedipine and was divided in the following groups: (1) Sham+V (n=10): Sham-operated males with vehicle used; (2) Sham+N (n=13): Sham-operated males treated with nifedipine (10 mg/kg/day); (3) 2K/1C+V (n=14): 2K/1C-operated males with vehicle used; and (4) 2K/1C+N (n=16): 2K/1C-operated males treated with nifedipine. RESULTS: The data indicated an association between hypertension induced by the 2K/1C model and reduction of reproductive function, as demonstrated by an impairment of sexual behavior, higher plasma PRL and lower plasma testosterone and FSH. The treatment with nifedipine prevented the reduction of sexual behavior and the increase of plasma PRL, but did not alter the reduction of plasma testosterone and FSH and spermatogenesis of 2K/1C rats. CONCLUSIONS: Reproductive function is adversely affected in the 2K/1C animal model, and high blood pressure plays a role in the modulation of plasma PRL and sexual behavior. Moreover, other events, without high blood pressure, but with high plasma renin activity associated with the 2K/1C model, contribute directly to the reduction of plasma testosterone and FSH and impaired spermatogenesis.     

Erectile impotence precipitated by organic factors and perpetuated by performance anxiety.

A survey of 72 men with erectile impotence showed that for 14 the onset had been concurrent with the start of a temporary physical disability (in 8), temporary exposure to a chemical agent in doses thought to be significant (in 4) or the return of sexual opportunity after a long period of celibacy or near-celibacy (in 2 older men). After elimination of that possible cause the impotence had persisted owing to anxiety about sexual performance. In another 6 of the 72 there were persistent nonpsychic causes for the impotence. Thus, in 28% of the men surveyed the precipitating cause of erectile impotence was organic. A large proportion of the cases of erectile impotence participated by a temporary nonpsychic factor could probably have been prevented with appropriate professional advice--for example, at the time an antihypertensive drug capable of causing the dysfunction was first prescribed.     

Neurotransmitter, opiodergic system, steroid-hormone interaction and involvement in the replacement therapy of sexual disorders

Dopamine (DA) and serotonin (5-HT) are the neurotransmitters most directly involved in sexual activity. DA plays a stimulatory role while 5-HT has an inhibitory effect. The two monoaminergic systems modulate the secretion of many hormones (GnRH, LH, testosterone, prolactin and endorphins) involved in sexual functional capacity. Furthermore, hormones influence synthesis and storage of brain neurotransmitters. Impotence can often be associated to clinical depression and altered neurotransmitter function. Moreover, stress represents an unbalance between various neurotransmitter systems and can induce impotence especially when disorders of the endorphinic system are present. Replacement therapy is based upon the understanding of these basic concepts. Impotence due to an underlying depressive illness must be treated with dopaminergic antidepressant drugs; while in stressful conditions a good response to the naloxone test is the preliminary criterion to subsequent naltrexone treatment. When a hormonal deficiency has been proved, the hormone replacement therapy is of course highly effective (gonadotropins in hypogonadotropic syndromes, testosterone in aging, etc.). Finally, idiopathic impotence could be treated by DA agonist and/or 5-HT antagonist drugs either alone or better yet in association with psychotherapy.     

46,XX SRY-Positive Male Syndrome Presenting with Primary Hypogonadism in the Setting of Scleroderma

ObjectiveTo describe a case of SRY gene translocation in a man with scleroderma presenting with primary hypogonadism.MethodsWe present the clinical, physical, laboratory, and pathologic findings of the study patient and discuss the cytogenetic analysis and the cause of the sexual dysfunction. Relevant literature is reviewed.ResultsA 35-year-old man with a recent diagnosis of diffuse cutaneous sclerosis was referred by his rheumatologist because of a low testosterone level. His medical history was notable for right cryptorchidism corrected after birth. He had no history of sexual activity, but reported normal erectile function before his current presentation. Physical examination findings were remarkable for a height of 157.5 cm; weight of 72.7 kg; extensive, diffuse thickening of the skin; mild gynecomastia; little axillary and pubic hair; and soft testes (1-2 mL bilaterally). Initial laboratory testing revealed the following values: follicle-stimulating hormone, 22.1 mIU/mL (reference range, 1.4-18.1 mIU/mL); luteinizing hormone, 19.7 mIU/mL (reference range, 1.5-9.3 mIU/mL); total testosterone, 25 ng/dL (reference range, 241-827 ng/dL); and free direct testosterone, 0.8 pg/mL (reference range, 8.7-25.1 pg/mL). Laboratory test results were consistent with primary hypogonadism. A urologist performed testicular biopsy, which showed severe testicular atrophy with absent spermatogenesis. Primary hypogonadism due to Klinefelter syndrome or testicular fibrosis secondary to scleroderma was suspected. Karyotype analysis showed a 46,XX karyotype, and fluorescence in situ hybridization was consistent with a 46,XX,Xp22.3(SRY +) gene translocation. After a normal prostate-specific antigen level was documented, testosterone replacement therapy was initiated, and he was referred for genetic counseling.ConclusionsThe 46,XX SRY-positive male syndrome is rare. Adult diagnosis can be challenging because of normal sexual development. Scleroderma, which rarely can occur in Klinefelter-type syndromes, further complicated the diagnosis in this case. (Endocr Pract. 2011;17:95-98)     

Gonadal function in young adults after surgical treatment of cryptorchidism.

In a follow-up study of 48 young men who had been surgically treated for cryptorchidism before puberty testicular function was assessed by examining the genitalia, testicular volume, secondary sex characteristics, semen, plasma luteinising hormone (LH) and follicle-stimulating hormone (FSH) concentrations after luteinising hormone-releasing hormone stimulation, and plasma testosterone concentrations. Clinical androgen effects were normal. The mean testicular volume of both testes was in the low normal range in those who had had unilateral cryptorchidism and below normal in those who had had bilateral cryptorchidism. Of 37 patients whose sperm counts were recorded (14 bilateral) six showed azoospermia (all bilateral), five had severe oligospermia (four bilateral), and 10 had moderate oligospermia (one bilateral). In nearly all those who had had bilateral cryptorchidism and most of those who had had unilateral cryptorchidism plasma gonadotrophin levels were increased. Four cases of possible partial LH deficiency were identified. Plasma testosterone concentrations were normal in all except two patients.     

Analyse du statut spermatique, érectile et hormonal chez des patients hémodialysés

Introduction

Our work was to establish the hormonal, semen and erectile profile among haemodialysed patients and to seek the impact of hormonal disturbances on erectile function and semen parameters.

Patients and methods

We conducted a cross-sectional study in haemodialysed patients in whom a semen, in parallel with hormonal analyses including FSH (follicle stimulating hormone) and testosterone. Erectile function was assessed by the study of the international index of erectile function in its French version (IIEF). Analyses of sex hormones were done by radio immunoassay and semen analyses according to WHO guidelines.

Results

Two patients had a semen analysis and a normal hormone balance; the IIEF was normal in a one patient. Azoospermic patients (16%) showed a hypergonadotrophic eugonadism. Forty percent of the patients had hypospermia without any correlation between hypospermia and hormonal values. One third of patients showed severe oligospermia associated with high levels of FSH in 77% of cases. Sperm motility and morphology were altered in 96% and 50% of the cases respectively. Hormonal analyses showed an elevated FSH (> 8.5 mUI/ml) in 40% of the cases and testosterone was decreased (< 3.2 ng/ml) in 25% of the cases.

Discussion

Semen volume was significantly decreased in patients over 30 years. Erectile function was disturbed in 73% of the patients with a mean IIEF score of 15. Several authors have shown a correlation between gonadal dysfunction and high levels of gonadotropins in men with chronic renal insufficiency, with or without testicular atrophy. In our series, testosterone was normal despite the absence of androgen. Are haemodialysis sessions effective in preserving the endocrine function?

Conclusion

Patients in chronic haemodialysis for a period exceeding one year had a hypergonadotrophic eugonadism and a severe erectile dysfunction. The state of the genital tract was relatively preserved. The duration of haemodialysis did not significantly affect sperm and erectile function. Patients older than 30 years showed a significant decrease in semen volume, which could be a marker to determine the impairment of erectile and reproductive functions.     

A protein family immunorelated to a sperm-binding protein and its regulation in human semen

In human seminal plasma a family of proteins that is immunologically related to the RSV-IV protein secreted under androgen control from the epithelium of the rat seminal vesicles was detected by a radioimmunoassay. Evidence for the origin of these antigens from human seminal vesicle is presented. Quantitative measurements of this family of proteins were performed in men with low levels of serum testosterone (idiopathic hypogonadotropic hypogonadism) and in individuals having serum testosterone in the normal range of values but carrying sex chromosome aberrations (Klinefelter's syndrome). In the first case we have found a marked decrease in the total amount of the RSV-IV-related proteins. An increase of about 40% in the total amount of these antigens was obtained in these subjects by gonadotropin treatment. A decreased amount of these proteins was also detected in the subjects affected by Klinefelter's syndrome. The possibility that some factor(s) under genetic control is involved, in addition to testosterone, in the regulation of this family of proteins is discussed.     

Investigative strategy of hyperandrogenism in women

Investigative procedures in the assessment of female hyperandrogenism are reviewed. Based on their experience, the authors suggest an inexpensive investigative strategy in hyperandrogenic females consisting of the following: the first step depends upon the clinical symptoms--in cases of hirsutism with regular menstrual cycles, plasma testosterone (T) and plasma dehydroepiandrosterone sulfate (DHA-S) are assayed, and the basal body temperature chart is recorded. In cases of hirsutism with irregular or anovulatory menstrual cycles, in addition to T and DHA-S, plasma 17-hydroxyprogesterone and urinary-free cortisol are assayed. In case of anovulation without hirsutism, T and DHA-S are assayed, and the LHRH test is performed. The results of this first investigation allow to attribute to the woman one of the six following hormone profiles: (1) metabolic hyperadrenalism; (2) tumoral hyperandrogenism; (3) 21-hydroxylase defect; (4) nontumoral DHA-S increase; (5) nontumoral ovarian hyperandrogenism; (6) idiopathic hirsutism. The additional investigative procedures required in each of these groups are detailed.     

The role of serum testosterone testing: routine hormone analysis is an essential part of the initial screening of men with erectile dysfunction

As oral phosphodiesterase-5 inhibitor therapy has become the first-line treatment of erectile dysfunction (ED), common approaches in the evaluation of ED have been largely abandoned. Not only is routine hormone analysis no longer widely recommended, but most specialists perform serum testosterone level testing only in the most complex cases of ED. This article explores the rationale for including serum testosterone analysis as part of the initial screening of patients with ED. The use of routine serum testosterone testing is advocated for its efficacy in the diagnosis and treatment of hypogonadism and pituitary disorders associated with ED.     

血清泌乳素水平对泌乳素瘤患者的临床价值研究

目的:分析术前血清泌乳素水平对泌乳素瘤患者的临床价值。方法:选择2011年1月至2016年12月于青岛大学附属医院行垂体腺瘤切除术且术前测得泌乳素(prolactin,PRL)水平、术后行病理免疫组化染色的垂体腺瘤164例,通过Spearman相关分析PRL水平与肿瘤大小的相关性,通过Kappa值判断PRL水平与病理诊断的一致性。采用ROC曲线获得PRL水平最佳临床诊断临界值。结果:(1)164例垂体瘤患者中,病理诊断单激素PRL瘤25例,主要表现为男性性功能低下及头痛、头晕,女性月经紊乱、闭经、泌乳;(2)术前PRL水平与年龄、性别无显著相关性(P均0.05),与肿瘤大小呈中度正相关(r=0.530,P0.05);(3)以正常范围上限值(23.3 ng/m L)为基线,分别以PRL23.3 ng/mL(1倍)、46.6 ng/m L(2倍)、69.9 ng/ml(3倍)、100 ng/mL、150 ng/m L、200 ng/mL为诊断标准,与病理免疫组化的一致性分析显示PRL69.9ng/m L作为诊断标准时符合率和Kappa系数最高,分别为82.3%和0.533;(4)以病理免疫组化作为诊断金标准作泌乳素瘤ROC曲线,以血清PRL为69.785 ng/m L作为诊断标准时,曲线下面积最大,此时符合率和Kappa系数分别为82.3%和0.553,灵敏度49.1%,特异度98.3%。结论:泌乳素瘤血清学诊断与病理免疫组化诊断一致性较高,血清PRL水平69.9 ng/mL(3倍于正常上限值)是诊断泌乳素瘤的最佳参考值。     

Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism.

Polycystic ovaries were defined with ultrasound imaging in a series of 173 women who presented to a gynaecological endocrine clinic with anovulation or hirsutism. Polycystic ovaries were found in 26% of women with amenorrhoea, 87% with oligomenorrhoea, and 92% with idiopathic hirsutism--that is, hirsutism but with regular menstrual cycles. Fewer than half the anovulatory patients with polycystic ovaries were hirsute, but in 93% of cases there was at least one endocrine abnormality to support the diagnosis of polycystic ovaries--that is, raised serum concentrations of luteinising hormone, raised luteinising hormone: follicle stimulating hormone ratio, or raised serum concentrations of testosterone or androstenedione. This study shows that polycystic ovaries, as defined by pelvic ultrasound, are very common in anovulatory women (57% of cases) and are not necessarily associated with hirsutism or a raised serum luteinising hormone concentration. Most women with hirsutism and regular menses have polycystic ovaries so that the term "idiopathic" hirsutism no longer seems appropriate.     

Rat lymphoma cell bioassay for prolactin: Observations on its use and comparison with radioimmunoassay

The rat Nb₂ node lymphoma cell bioassay (BA) for prolactin (PRL) was validated for use in our laboratories. During the course of this validation we observed that rat prolactin (NIAMDD-RP-1) stimulated cell division by as much as 16.5 fold over the range of 0.04 to 40.0 ng/ml at the end of 72 hours of incubation. We also observed a dose related increase in the size of the lymphoma cells. Prolactin concentrations in rat plasma, serum, anterior pituitary (AP) homogenates and milk were measured by both radioimmunoassay (RIA) and BA. In individual BA's there was parallelism between samples and standard; but when several dilutions of the same plasma and pituitary homogenates were assayed repeatedly, higher PRL levels were consistently observed for the more concentrated samples. At low or moderate levels of plasma PRL there was excellent agreement between RIA and BA; however, at high levels plasma PRL bioactivity exceeded radioimmunoactivity by a small, but significant, amount. A comparison of pituitary PRL concentrations measured by RIA and BA were in good agreement when homogenization was done at pH 10.6. However, when homogenization was done at pH 7.6, slightly but significantly more PRL was extracted when assayed by BA than when assayed by RIA.