Introduction: Endocrinopathies are rare causes of erectile dysfunction and previously cases of hyperprolactinaemia and pituitary adenomas have been reported.
Case report: We present the clinical case of a 27-year old male, married for 4 years with no children, presented with possible infertility and erectile dysfunction which was previously interpreted as caused by a poor social and psychological situation in the family. After additional endocrinological (mildly elevated prolactin levels and reduced levels of testosterone) and radiological (skull X-ray, CT scan and MRI) an underlying subependymoma was discovered. The subependymoma was expanding in the sellar and suprasellar regions and pressing against the pituitary gland. The patient experienced occasional periorbital and temporal headaches, loss of appetite, general weakness. A Goldman perimeter test was consistent with bitemporal hemianopia. The resulting endocrine disorder caused the problems which were subjectively at first mainly manifested as erectile dysfunction. The patient underwent a left-sided supraorbital craniotomy and complete surgical removal of the tumor at the Department of Neurosurgery. The histopathology findings described a subependymoma (G II). One year after surgery, the patient was in good general condition, but with bitemporal hemianopia, with atrophy of the right optic nerve and complete loss of vision in his right eye, panhypopituitarism and impotence. Two years later, with hormone replacement therapy (desmopressin, hydrocortisone, levothyroxine, testosterone undecanoate) there was no sexual dysfunction.
Conclusions: The case is an educative example about the necessity to keep possible intracranial lesions in mind when starting the workup of a patient presenting with erectile dysfunction. It may be of broad clinical interest not only for endocrinologists, but for practitioners in various fields.