Endocrine Abstracts

Our knowledge about sexual dysfunction during the treatment of patients with prolactinoma is limited. The sexual dysfunction may not improve or turn out a different form as in our patient. Delayed ejeculation (DE) is a complex form of male sexual dysfuntion, characterized by a considerable delay in ejaculation or an inability to complete ejaculation. Both organic and psychogenic etiologies can cause DE, however the pathophysiology is indefinite. In this case, we present a male patient who had developed delayed ejeculation during his follow-up period. A 33-year-old male patient was admitted to our outpatient clinic with complaints of loss of libido, impotence and premature ejaculation. His hormone profile showed hyperprolactinemia, prolactin level was determined as b 200 ng/ml and magnetic resonance imaging (MRI) of the pituitary revealed a macroadenoma. The patient diagnosed as a prolactinoma and cabergoline was started 1 mg per week. Four months after cabergolin, prolactin level was 0.63 ng/ml (2.64–13.13). The patient’s loss of libido regressed, but initially described delayed ejaculation rather than pre-existing premature ejaculation. He presented with different patterns of sexual dysfunction in his follow-up period. The effects of prolactin on the male reproductive system have not been clearly elucidated yet. Hyperprolactinemia disrupts the pulsatile secretion of GnRH and cause sexual dysfuntion. Recovery of sexual dysfunction is expected after treatment with dopamine agonists. However, the long-term suppression of the stimulating pathways in the hypothalamus and the psychological reasons caused by the initial complaints in the patients may be effective in persisting sexual dysfunction. Delayed ejeculation is a multifactorial condition that can be both organic and psychogenic, and the pathophysiology is unclear. Hypoprolactinemia was found to be associated with metabolic syndrome and worse glycemic and lipid control. In a study a higher prevalence of erectile dysfunction was found in patients with hypoprolactinemia, but no difference was found in the prevalence of DE. As a conclusion, there isn’t enough data in the literature regarding sexual dysfunction in patients with prolactinoma during the follow-up period. In our patient, the psychological reasons caused by the initial complaints may also lead to development of delayed ejaculation. With this case presentation, we aimed to highlight the need to increase the number of studies on sexual dysfunction in the follow-up of patients with prolactinoma.

Key words: Prolactinoma, erectil dysfunction, sexual dysfunction, delayed ejeculation, cabergolin