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IJPR 9[3] July - September 2017 Special Issue

July - September 9[3] 2017

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Individual properties of therapeutic and diagnostic tactics applied in patients suffering from erectile dysfunction in combination with «empty sella syndrome”

Abstract: Annotation: The main purpose of this study is to improve the results of diagnosis and treatment in patients burdened with erectile dysfunction (ED), in combined with the empty sella syndrome (ESS). Materials and methods: For research purpose were selected and studied examination and treatment results of 118 patients suffering from induced ED ages from 23 to 57. The severity of erectile dysfunction and the signs of androgen deficiency were assessed by means of administering an AMS questionnaire and the Morley scale, also penile ultrasound was performed with intra cavernous pharmacological tests and finally patient’s hormonal statuses were evaluated. In cases when suspected neuroendocrine pathology arises, an MRI of the brain is performed. All of the study subjects previously have not suffered from “empty Sella syndrome"(ESS). The ESS was diagnosed accidently, as the patients came in to be treated primarily for erectile dysfunction. None of the participants have been subjected previously to means of systemic treatment with use of medication that could potentially induce hypopituitarism, in particular like the anabolic steroids. Fertility assessment was not carried out, because the main subjects of treatment in patients was the lack of erectile function, most of the participants were married, and had had children, from which we can deduct that these patient were fertile. Results. All examined patients showed signs of decreased erectile function. In 62 cases (52.5%) out of 118, the MRI revealed a picture of an “empty Sella syndrome”. In 22 (18,6%) cases subjects had ocular fundus changes, which was indicating an increase in intracranial pressure, but loss of visual fields was not observed in any of the study subjects. Persistent headaches were noted in 19 (16.1%) cases. In 46 (39%) cases, patients with significant levels of obesity showed signs of impaired glucose tolerance (IGT) and insulin resistance (IR). In complex treatment of ED patients with detected hormonal disorders, hormonal replacement therapy was prescribed (hCG in combination with testosterone), while dopamine receptor agonists were used in the individual dosage under the control of prolactin levels to detect hyperprolactinemia. Mandatory treatment of intracranial hypertension with the use of osmotic diuretics was performed on all patients. In all cases, therapy was effective; during the course of treatment, an increase in the frequency and duration of sexual acts was noted. During control penile Doppler examinations, an improvement in regional hemodynamic was noted. Cancellation of medication treatment has led to the resumption of disease`s symptoms. Conclusion. The study demonstrates significance of the ESS in the pathogenesis of ED. It is important to note that ESS, in most cases, is a random tomographic finding, often accompanied by impaired glucose tolerance, obesity, and metabolic syndrome. ESS must be clearly diagnosed and, if necessary, prescribe etiotropic and pathogenic therapies. For correct diagnosis, treatment and monitoring of the ESS, a multidisciplinary approach is required involving adjacent specialists - endocrinologists, neurologists and ophthalmologists.
Keyword: Erectile dysfunction, «Empty Sella syndrome», morbid obesity, hormonal replacement therapy.
DOI: https://doi.org/10.31838/ijpr/2019.11.01.119
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