Introduction: Erectile dysfunction (ED) is quite common. It poses a problem of diagnosis and management given the multiplicity of contributing factors and etiologies that can sometimes be unrecognized.
Observations: We report 3 observations of patients followed for insulin-requiring diabetes. The average age was 51. They had ED for 3.5 years on overage. The clinical examination of our patients showed obesity or weight excess. The impact assessment of diabetes showed diabetic retinopathy in all cases. HbA1c was 8.3%. Hormonal exploration has objectified a biological hypogonadism with a central look. The complete hypophysiogram did not show other abnormalities. Pituitary imaging revealed an empty sella. The dosage of PSA, ferritinemia and prostate ultrasound are normal. Ophthalmological examination and visual field did not show abnormalities. In addition, conversion enzyme assay, chest X-ray and abdominal ultrasound and salivary gland biopsy are normal. Androgenic treatment was initiated using the necessary precautions. Improvement of symptomatology is obtained in all cases. Clinical, biological and hormonal monitoring is planned.
Discussion: Our observation illustrates the interest of the hormonal exploration of ED for the diabetic. A hypothalamic-pituitary pathology can be at the origin of this symptomatology. The appearance of empty sella is rare in humans especially in men. Etiological exploration is necessary. A secondary empty sella must to be considered. The hypothesis of hemochromatosis, especially in diabetics, must be advanced. For our patients, the etiological exploration is negative but the hypothesis of diabetic microvascular involvement remains plausible in our patients since they have diabetic retinopathy.
18 - 21 May 2019
European Society of Endocrinology