Achievement of fertility in an infertile man with resistant macroprolactinoma using high-dose bromocriptine and a combination of human chorionic gonadotropin and an aromatase inhibitor.
OBJECTIVE
To describe the achievement of fertility in an infertile man with a resistant macroprolactinoma by using high-dose bromocriptine and a combination of human chorionic gonadotropin (hCG) and an aromatase inhibitor.


METHODS
We present historical features and results of clinical, laboratory, and imaging evaluation in a man with secondary infertility attributable to a resistant macroprolactinoma.


RESULTS
We report a case of macroprolactinoma in a 36-year-old infertile man who failed to attain a normal serum testosterone level and fertility with use of either bromocriptine or cabergoline treatment. Testosterone replacement or hCG therapy in this patient resulted in an increase in serum prolactin levels, which declined after discontinuation of this therapy. The combination of high doses of bromocriptine, hCG, and an aromatase inhibitor facilitated near-normalization of serum prolactin levels, shrinkage of the macroprolactinoma, recovery of serum testosterone levels, sexual function, and sperm count, and achievement of fertility.


CONCLUSIONS
An aromatase inhibitor may facilitate successful testosterone replacement therapy in male patients with prolactinoma.
Heidari
Zahra
Z
Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
Hosseinpanah
Farhad
F
Shirazian
Nahid
N
D000328:Adult; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001971:Bromocriptine / Q000008:administration & dosage / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D019008:Drug Resistance, Neoplasm; D004359:Drug Therapy, Combination; D005687:Galactorrhea / Q000209:etiology; D020249:Hormone Replacement Therapy; D006801:Humans; D007248:Infertility, Male / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D010911:Pituitary Neoplasms / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D015175:Prolactinoma / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D013739:Testosterone / Q000097:blood / Q000172:deficiency; D047368:Tumor Burden / Q000187:drug effects
D047072:Aromatase Inhibitors; D006063:Chorionic Gonadotropin; D018491:Dopamine Agonists; D001971:Bromocriptine; D013739:Testosterone