title: [Pituitary prolactinoma with severe erectile dysfunction as the initial symptom: diagnosis and treatment of 4 cases].
abstract: 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 hypophysectomy. 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).
  
  
  CONCLUSIONS
  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.
authors: Department of Urology, The First Hospital Affiliated to Dalian Medical University, Dalian, Liaoning 116011, China.
authors: Tao
authors: T
authors: Jiang
authors: Lei
authors: L
authors: Zheng
authors: Xiao-Ming
authors: XM
authors: Su
authors: Jin-Qiang
authors: JQ
authors: Peng
authors: Dong-Chen
authors: DC
authors: Sun
authors: Quan-Lin
authors: QL
authors: Li
authors: Zhi-Wei
authors: ZW
authors: Zhang
authors: Fa-Peng
authors: FP
authors: Wang
authors: Hui
authors: H
authors: Jiang
mesh_terms: D000328:Adult; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D015175:Prolactinoma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D058986:Phosphodiesterase 5 Inhibitors