以重度ED为首发症状的垂体泌乳素瘤4例报告

目的:以重度ED为首发症状的垂体泌乳素瘤易误诊,分析该病所致重度ED的特点,以提高诊治水平。方法:回顾4例以重度ED(IIEF-5评分5～7分)为首发临床症状、经MRI检查确诊的垂体泌乳素瘤,结合文献诊治特点进行分析。结果:4例因垂体泌乳素瘤引起的重度ED误诊时间长达2年,血清泌乳素(PRL)均为正常高值的10倍以上,开始应用PDE5抑制剂无效,3例行单鼻孔-蝶窦-垂体瘤全切除术,术后24个月随访:1例PRL正常,IIEF-5 19分,2例PRL分别降至600和768 IU/L,IIEF-5均为15分,此时再服用PDE5抑制剂获得满意效果;1例口服溴隐亭保守治疗,12个月后随访PRL正常,IIEF-5>21分。结论:检测血PRL和脑MRI检查可以确诊以重度ED为首发临床症状的垂体泌乳素瘤,在PRL极高的情况下,单纯应用PDE5抑制剂无效,通过手术或药物降低PRL后,ED症状可改善,若改善不明显,此时再应用PDE5抑制剂将会收到满意的效果。

Pituitary prolactinoma with severe erectile dysfunction as the initial symptom:Diagnosis and treatment of 4 cases

Objective: Pituitary prolactinoma with severe erectile dysfunction(ED) as the initial symptom is often misdiagnosed.This article explores the diagnosis and treatment of severe ED caused by pituitary prolactinoma.Methods: We retrospectively analyzed the diagnosis and treatment of 4 cases of pituitary prolactinoma with severe ED(IIEF-5 score 5-7) as the initial clinical symptom confirmed by MRI.Results: The 4 cases of pituitary prolactinoma-induced severe ED,with serum prolactin 10 times above the maximum normal level,were misdiagnosed for 2 years.All failed to respond to the PDE5 inhibitor therapy,and then 3 of them underwent transnasal hypophysiectomy.Twenty-four months of follow-up found the level of prolactin restored to normal in 1 case(IIEF-5 = 19),and reduced to 600 and 768 IU/L respectively(IIEF-5 = 15) in the other 2.Then administration of the PDE5 inhibitor was followed,which produced satisfactory efficacy.One case was treated with oral bromocriptine,which restored the prolactin level to normal at 12 months(IIEF-5 > 21).Conclusion: Prolactin detection and brain MRI can help to confirm pituitary prolactinoma with severe ED at the onset.As for its treatment,in case of an extremely high level of prolactin,simple administration of the PDE5 inhibitor is ineffective.When the prolactin level is reduced after surgery or medication,the symptom of ED can be improved and,in case of no obvious relief,administration of the PDE5 inhibitor can be followed,which may achieve satisfactory results.