ergoline and Erectile-Dysfunction

Among the various endocrine forms impotence associated with hyperprolactinaemia is discussed in this paper. A more relevant clinical picture is particularly due to prolactinoma. A marked reduction or suppression of libido and sexual power are mostly present; sometimes an altered spermatogenesis with oligospermia and infertility may be found; on the contrary galactorrhea and gynaecomastia are less frequent. Symptoms and signs of hypopituitarism or extrasellar growth may be found too. The main physiopathologic aspects as well as biochemical and instrumental diagnostic evaluation methods of prolactinoma in men are examined. The treatment may be pharmacological, surgical or radiant: indications and efficacy of each one are reported. A guide-line in case of macro- or microprolactinoma is explained too. With regard to pharmacological treatment, dopaminergic agonists have been available for more than twenty years and there is a wide experience with bromocriptine. Among the latest dopaminergic agonists, cabergoline is very interesting because it is effective, selective and long-term active; its pharmacological features are mentioned. At last, personal experience in three men, one suffering from micro- and two from macroprolactinoma recently treated with cabergoline is reported. Clinical aspects and hormonal and instrumental data before treatment are presented. Clinical and hormonal evaluations have been made after 2, 3 and 6 months of therapy and TAC control after the sixth month. The results allowed to verify the effectiveness of the drug.

Topics: Cabergoline; Cranial Irradiation; Dopamine Agonists; Erectile Dysfunction; Ergolines; Galactorrhea; Gynecomastia; Humans; Hyperprolactinemia; Hypophysectomy; Infertility, Male; Libido; Male; Pituitary Neoplasms; Prolactinoma; Treatment Outcome

Topics: Adrenocorticotropic Hormone; Amenorrhea; Blood Glucose; Cushing Syndrome; Erectile Dysfunction; Ergolines; Female; Galactorrhea; Gonadotropins; Growth Hormone; Hormones; Humans; Lactation; Luteinizing Hormone; Male; Metergoline; Pancreatic Hormones; Pimozide; Pituitary Gland; Postpartum Period; Pregnancy; Prolactin; Receptors, Dopamine; Serotonin Antagonists; Thyrotropin

This open longitudinal study investigated the prevalence of depressed sexual potency by monitoring erectile dysfunction using nocturnal penile tumescence (NPT) in 51 consecutive men with hyperprolactinemia (41 macroprolactinomas and 10 microprolactinomas) and evaluated potential reversibility of sexual failure after 6 months of treatment with cabergoline. Fifty-one healthy men served as controls. Compared with controls, the patients with either micro- or macroprolactinoma had low testosterone levels with severe alterations of erectile function. Testosterone deficiency was present in 73.2% of macro- and 50% of microprolactinomas; reduced libido and sexual potency were referred by 53.6% of macroprolactinomas, 50% of microprolactinomas, and none of controls. Fewer than three erectile events per night by NPT were found in 96.7% of patients and 13.7% of controls (P < 0.0001). After 6 months of cabergoline treatment, prolactin levels normalized in 74.5% of patients: 73.2% of macroprolactinomas and 80% of microprolactinomas. Testosterone levels normalized in 68.6% of patients, whereas NPT normalized in 60.6% of patients who had normalized prolactin levels and in 7.7% of patients who did not. In conclusion, at study entry, 50% of the patients complained of sexual disturbances, 96.7% of whom had an impairment of erectile events per night compared with 13.7% of controls. Six months of treatment with cabergoline normalized testosterone levels in most cases, thus restoring and maintaining during treatment the capability of normal sexual activity in hyperprolactinemic males.

Topics: Adult; Cabergoline; Case-Control Studies; Circadian Rhythm; Dopamine Agonists; Drug Administration Schedule; Erectile Dysfunction; Ergolines; Humans; Hyperprolactinemia; Longitudinal Studies; Male; Middle Aged; Penile Erection; Testosterone; Treatment Outcome

Topics: Adult; Brain; Cabergoline; Dopamine Agonists; Erectile Dysfunction; Ergolines; Headache; Humans; Magnetic Resonance Imaging; Male; Nipple Discharge; Pituitary Neoplasms; Prolactinoma

Topics: Adenoma; Adult; Cabergoline; Dopamine Agonists; Erectile Dysfunction; Ergolines; Humans; Hyperprolactinemia; Male; Pituitary Neoplasms; Treatment Outcome

We present the case of a 60 year old male patient with incidentally detected visual abnormalities. Detailed personal history revealed a hypogonadism that had been present for several years. Further investigations established the diagnosis of an infiltrative macroadenoma. Medical treatment with cabergoline led to a rapid regression of ophthalmologic symptoms and, subsequently, of tumor size. In male subjects symptoms of hypogonadism are often reported only late in the course of the disease, thereby leading to a generally larger tumor size at the point of diagnosis. In contrast to other pituitary tumors that are mainly treated by surgery, medical treatment with dopamine agonists is the principal therapeutic option in prolactinomas.

Topics: Cabergoline; Diagnosis, Differential; Dopamine Agonists; Erectile Dysfunction; Ergolines; Humans; Hyperprolactinemia; Hypogonadism; Libido; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Compression Syndromes; Optic Nerve Diseases; Pituitary Neoplasms; Prolactinoma; Visual Fields

The term 'giant prolactinoma' can be used for tumours larger than 4 cm in diameter and/or with massive extrasellar extension. Cabergoline (CAB), a long-lasting dopamine agonist (DA), safe and well tolerated, is effective in normalizing PRL levels and inducing tumour shrinkage in micro- and macroprolactinomas. The purpose of this prospective study was to evaluate the efficacy and safety of CAB also for giant prolactinomas.. Ten men with giant prolactinomas with a median age of 44.8 years were treated with CAB. Before CAB, four patients had previously undergone transsphenoidal surgery without modifying the parasellar extension of the tumour or their visual defects. Pretreatment serum prolactin (PRL) levels ranged between 1230 and 22 916 micro g/l (mean +/- SEM: 5794 +/- 1996) and tumour volume was between 21.8 and 105.5 cm3 (mean +/- SEM: 50.7 +/- 8.8). CAB was administered at an initial low dose of 0.5 mg three times a week and, in five patients who did not achieve serum PRL normalization, the dose was progressively increased up to 10.5 mg/week. The duration of treatment was 13-68 months (mean 38.9). PRL levels and pituitary target organ hormones were assayed before, after 30 days and then every 3 months after the beginning of CAB treatment. Magnetic resonance imaging (MRI) was carried out before, after 1-3 months, after 6 months and then every 10-12 months to evaluate tumour shrinkage.. In every patient, a significant PRL decrease (P = 0.0086) of at least 96% of the pretreatment values occurred (from 5794 +/- 1996 to 77 +/- 38, mean +/- SEM); a persistent normalization of PRL levels was achieved in five out of 10 patients (50%) beginning from the first 3-6 months of CAB treatment (only one patient needed 12 months of therapy). A significant tumour shrinkage (P = 0.0003) was achieved after 12 months of therapy in nine out of 10 patients (90%), with a volume reduction greater than 95% in three, of 50% in four and 25% in two patients. Tumour volume decreased from 50.7 +/- 8.8 to 28.6 +/- 9.4 and then to 22.3 +/- 8.8 cm3 (mean +/- SEM) after 6 and 12 months of CAB treatment, respectively. An improvement of visual field defects (VFD) was obtained in six of the seven patients presenting visual impairment before CAB treatment. Among the eight patients presenting libido and potency (L-P) failure, five normalized their PRL levels. In two of these a complete restoration of libido and potency was observed. Three patients with secondary hypoadrenalism and a patient with secondary hypothyroidism were treated with substitutive therapy during all the study time. The drug was well tolerated by all patients and no one discontinued the therapy.. These data suggest that, in giant, aggressive prolactinomas, CAB represents a first-line therapy effective in reducing PRL levels and determining tumour shrinkage.

Topics: Adrenal Glands; Adult; Aged; Antineoplastic Agents; Cabergoline; Erectile Dysfunction; Ergolines; Humans; Hypothyroidism; Libido; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Gland; Pituitary Neoplasms; Prolactin; Prolactinoma; Vision Disorders

Topics: Adult; Aged; Arteritis; Erectile Dysfunction; Ergolines; Humans; Male; Middle Aged; Muscle Tonus; Nicergoline; Ultrasonography

One hundred ninety-one hyperprolactinemic patients (78 women and 13 men; 54 with pituitary macroadenoma, 53 with microadenoma, and 84 with idiopathic disease) were treated for 2 to 48 months with one or two of the following prolactin (PRL)-lowering drugs: bromocriptine, metergoline, and lisuride. All of the three drugs used were highly effective in lowering PRL levels and restoring gonadal function both in females and in males in the majority of patients with either idiopathic or tumorous disease. In poorly responsive patients, increasing the drug doses resulted in further PRL lowering for all the three drugs. Mild side effects were frequently encountered with initiation of drug treatment but spontaneously subsided in most cases; severe side effects, necessitating stopping of the treatment, occurred in only 12 instances, but changing of the drug allowed PRL-lowering treatment to be continued in 11 of them.

Topics: Adenoma; Adolescent; Adult; Amenorrhea; Bromocriptine; Erectile Dysfunction; Ergolines; Female; Galactorrhea; Humans; Lisuride; Male; Metergoline; Middle Aged; Ovarian Function Tests; Pituitary Neoplasms; Pregnancy; Prolactin; Visual Fields

In a group of 16 females and 2 males with hypogonadism and hyperprolactinemia, bromocriptine was found to suppress prolactin (PRL) high levels within one day without further significant lowering during a 3 weeks longitudinal survey. The usually effective dosage was 5 mg per day. On the contrary, sex hormones did not vary initially and increased secondarily only in those patients resuming gonadal activity. The changes were either cyclical or heterogenous when the first cycle was anovulatory. This latter situation could sometimes but not always be attributed to persistent hyperprolactinemia. Menstruation resumed in 11 patients. Persistance of hypogonadism in the remainder could be explained by incomplete PRL reduction in one case and probability of previous hypothalamo-pituitary damage in six. The latter hypothesis was based in part on impaired gonadotropins responses to LH RH which were not modified by the treatment.

Topics: Adolescent; Adult; Amenorrhea; Bromocriptine; Erectile Dysfunction; Ergolines; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Luteinizing Hormone; Male; Pituitary Gland; Prolactin; Secretory Rate; Testosterone; Time Factors