ABSTRACT
OBJECTIVES: To define the clinical and laboratory characteristics and natural history of Leydig cell tumours in order to define a general management plan. MATERIAL AND METHODS: The files of 10 patients operated for Leydig cell testicular tumour between 1982 and 1996 were studied retrospectively. RESULTS: In nine out of ten cases, the presenting complaint was gynaecomastia, erectile dysfunction or infertility. In every case, serum testosterone was normal or low and oestradiol was normal or elevated. Eight patients were treated by radical orchidectomy, and two by subcapsular orchidectomy. The course was favourable in 9 out of 10 cases in the absence of any other treatment. Only one patient had an immediately malignant form with a fatal outcome. CONCLUSION: Although many teams prefer total orchidectomy because of the diagnostic difficulty associated with malignant forms, simple subcapsular orchidectomy should become the first-line treatment, provided it is subsequently followed by close surveillance, as it preserves maximum fertility, and these tumours usually have a favourable prognosis.
Subject(s)
Leydig Cell Tumor/diagnosis , Testicular Neoplasms/diagnosis , Adult , Erectile Dysfunction/etiology , Follow-Up Studies , Gynecomastia/etiology , Humans , Infertility, Male/etiology , Leydig Cell Tumor/physiopathology , Leydig Cell Tumor/surgery , Male , Middle Aged , Orchiectomy , Prognosis , Retrospective Studies , Testicular Neoplasms/physiopathology , Testicular Neoplasms/surgeryABSTRACT
Hyperprolactinemia is the cause of erectile dysfunction in less than 1% of cases. From 1989 to 1996, 13 patients consulted for erectile disorders associated with hyperprolactinemia. The mean age was 47.5 years. 10 patients complained of decreased libido. 3 patients had gynecomastia. Plasma prolactin levels ranged from 31.3 ng/ml to 1,300 ng/ml. 7 patients had a plasma testosterone less than 4 ml/ng. 7 patients had a micro- or macroadenoma of the sella turcica visualized by MRI. After drug treatment, plasma prolactin levels returned to normal in all patients in whom assays were performed. 6 patients considered that their erectile function was restored. 5 of the 6 patients with no improvement of their sexual function had a concomitant disease able to explain the impotence. Hyperprolactinemia is a rare cause of erectile dysfunction, but it must be considered in any patient presenting with idiopathic erectile dysfunction associated with decreased libido, gynecomastia, and decreased plasma testosterone. Drug treatment is effective and MRI of the sella turcica should be performed looking for a pituitary adenoma.
