ergoline and Infertility--Male

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: Androgens; Bromocriptine; Ergolines; Estrogen Antagonists; Glucocorticoids; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Immunosuppressive Agents; Infertility, Male; Kallikreins; Male; Pentoxifylline; Prostaglandin Antagonists; Testolactone; Testosterone

Cabergoline is now established as an effective and well-tolerated treatment for prolactinoma. However, there are relatively few published data on the treatment of macro-, as opposed to micro-, prolactinoma. We have therefore reviewed the efficiency and safety of cabergoline in the treatment of patients with prolactin-secreting macroadenomas treated on a compassionate basis.. Eighty-five patients with prolactin-secreting macroadenomas were treated with cabergoline 0.25 to 10.5 mg per week (median 1 mg) given to one to seven doses. Treatment durations ranged between 3 months and 8 years. Sixty-five patients (32 intolerant, 16 resistant) had been treated previously with other dopamine agonists. Pretreatment prolactin levels ranged between 80 and 8300 micrograms/I and tumour maximum diameters were between 11 and 42 mm.. Serum prolactin, visual fields if initially abnormal, occurrence of menses or return of libido and potency, blood chemistry and adverse events were assessed at 1 month and then at 3-month intervals during treatment. Pituitary computed tomography or magnetic resonance imaging was usually repeated at 3 months and 1 year, then yearly, in most patients (n = 62).. Normalization of prolactin levels was achieved in 52 patients (61.2%) and a prolactin decrease of at least 75% of pretreatment values occurred in 24 others (28.2%). Of the 20 de novo patients, 17 had prolactin normalized and the remainder had at least 75% reduction. Disappearance of tumour image was found in eight of 62 evaluable patients (12.9%) and reduction of the largest diameter by at least 25% in another 33 (53.2%), with an overall success rate of 66.1%; among the 17 evaluable de novo patients the success rate was 82.3%. Fifteen of 21 patients who failed to show tumour shrinkage had previously demonstrated resistance/intolerance to other prolactin-lowering treatments. Of the 12 patients with visual field defects at baseline, six normalized and two showed an improvement. Menses resumed during cabergoline treatment in 79.5% of premenopausal women. Restoration of potency was reported by seven of eight evaluable men. Adverse events were recorded in 24.7% of cases, four of whom (4.7%) discontinued treatment.. Although the present data were not obtained in a formal study we conclude that cabergoline is an effective and well-tolerated treatment for macroprolactinoma patients.

Topics: Adolescent; Adult; Aged; Antineoplastic Agents; Cabergoline; Dopamine Agonists; Ergolines; Female; Humans; Infertility, Male; Male; Menstruation Disturbances; Middle Aged; Pituitary Neoplasms; Prolactin; Prolactinoma

A total of 122 male subjects suffering from secretory infertility were examined. In 25 of them (20 percent) blood prolactin levels were above the norm. Measurements of basal prolactin levels and of its secretion in metoclopramide test helped distinguish two types of hyperprolactinemia syndrome, differing in the pattern of spermatogenesis disorders. Possible pathogenesis of individual types of hyperprolactinemia in men is discussed. Therapy with dopamine agonists (lisenyl, parlodel) was found most effective in Type I hyperprolactinemia syndrome, associated with essential prolactin hypersecretion and oligospermia.

Topics: Adult; Bromocriptine; Ergolines; Humans; Hyperprolactinemia; Infertility, Male; Lisuride; Male; Middle Aged; Oligospermia; Prolactin; Syndrome

Topics: Bromocriptine; Cell Count; Ergolines; Follicle Stimulating Hormone; Humans; Infertility, Male; Luteinizing Hormone; Male; Prolactin; Semen; Spermatozoa; Testosterone

As in patients with high pituitary prolactin secretion disturbances of the spermatogenesis are observed, we picked out from our patients with low sperm count those showing hyperprolactinemia without pituitary adenoma. They were treated for 50 days with 2-brom-alpha-ergocryptin (Pravidel, Sandoz AG, Nürnberg), which selectively inhibits prolactin release. Following treatment, in 7 cases an increase in sperm count was observed, while in 2 cases a decrease occurred. 4 cases with azoospermia showed no alteration. No explanation for the possible stimulation of spermatogenesis can be given today.

Topics: Ergolines; Humans; Infertility, Male; Male; Prolactin; Spermatogenesis