title: 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.
abstract: 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.
authors.affiliation: Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Heidari
authors.forename: Farhad
authors.initials: F
authors.lastname: Hosseinpanah
authors.forename: Nahid
authors.initials: N
authors.lastname: Shirazian
mesh_terms: 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
chemical_list: D047072:Aromatase Inhibitors; D006063:Chorionic Gonadotropin; D018491:Dopamine Agonists; D001971:Bromocriptine; D013739:Testosterone