Hyperprolactinaemia in male infertility: Clinical case scenarios

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Abstract

Objective

To explore the evaluation, treatment and impact of hyperprolactinaemia on male infertility and testicular function, as hyperprolactinaemia is commonly detected during the evaluation of infertile men.

Methods

A literature search was performed using MEDLINE/PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all studies exploring hyperprolactinaemia in male infertility.

Results

Elevated levels of serum prolactin have a detrimental effect on male reproduction through inhibition of the pulsatile release of gonadotrophins from the anterior pituitary gland, and a direct effect on spermatogenesis. Treatment of confirmed hyperprolactinaemia with dopamine agonists leads to significant improvements in both semen parameters and hormone levels.

Conclusion

Hyperprolactinaemia, both directly and indirectly, has a negative effect on sperm production, and its detection and management in men seeking fertility is mandatory.

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Most cited references 36

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Advances in the treatment of prolactinomas.

Mary P Gillam, Mark Molitch, Gaetano Lombardi … (2006)

Prolactinomas account for approximately 40% of all pituitary adenomas and are an important cause of hypogonadism and infertility. The ultimate goal of therapy for prolactinomas is restoration or achievement of eugonadism through the normalization of hyperprolactinemia and control of tumor mass. Medical therapy with dopamine agonists is highly effective in the majority of cases and represents the mainstay of therapy. Recent data indicating successful withdrawal of these agents in a subset of patients challenge the previously held concept that medical therapy is a lifelong requirement. Complicated situations, such as those encountered in resistance to dopamine agonists, pregnancy, and giant or malignant prolactinomas, may require multimodal therapy involving surgery, radiotherapy, or both. Progress in elucidating the mechanisms underlying the pathogenesis of prolactinomas may enable future development of novel molecular therapies for treatment-resistant cases. This review provides a critical analysis of the efficacy and safety of the various modes of therapy available for the treatment of patients with prolactinomas with an emphasis on challenging situations, a discussion of the data regarding withdrawal of medical therapy, and a foreshadowing of novel approaches to therapy that may become available in the future.

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Male factor infertility: evaluation and management.

M Brugh, L I Lipshultz (2004)

There is a male factor involved in up to half of all infertile couples. Potential etiologies in male factor infertility are many and require thorough evaluation for their accurate identification. A complete medical history in conjunction with a focused examination can allow for an appropriate choice of laboratory and imaging studies. The semen analysis is a crucial first step, but by no means is it sufficient to determine a specific etiology or dictate therapy. A systematic approach is necessary to help guide the work-up and rule out less likely causes. The etiologies discussed within this article are tremendously broad, and the prognosis for any given couple depends, in large part, on the etiology. Without a firm understanding of the genetics, anatomy, physiology, and complex interplay of the male reproductive system, the evaluation becomes an inefficient exercise that often fails to define the precise etiology. Couples with male factor infertility need a systematic approach with the efficiency of ultimate treatment determined largely by the physician's ability to identify the specific cause of the man's reproductive failure.

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Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia.

Rosario Pivonello, Antonella Di Sarno, Paolo Cappabianca … (2003)

Whether the withdrawal of treatment in patients with nontumoral hyperprolactinemia, microprolactinomas, or macroprolactinomas is safe and effective has been unclear. We performed an observational, prospective study of cabergoline (a dopamine-receptor agonist) withdrawal in such patients. The study population included 200 patients--25 patients with nontumoral hyperprolactinemia, 105 with microprolactinomas, and 70 with macroprolactinomas. Withdrawal of cabergoline was considered if prolactin levels were normal, magnetic resonance imaging (MRI) showed no tumor (or tumor reduction of 50 percent or more, with the tumor at a distance of more than 5 mm from the optic chiasm, and no invasion of the cavernous sinuses or other critical areas), and if follow-up after withdrawal could be continued for at least 24 months. Recurrence rates two to five years after the withdrawal of cabergoline were 24 percent in patients with nontumoral hyperprolactinemia, 31 percent in patients with microprolactinomas, and 36 percent in patients; with macroprolactinomas. Renewed tumor growth did not occur in any patient; in 10 female patients (22 percent) and 7 male patients (39 percent) with recurrent hyperprolactinemia, gonadal dysfunction redeveloped. In all diagnostic groups, prolactin levels at the time of recurrence were significantly lower than at diagnosis (P<0.001). The Kaplan-Meier estimated rate of recurrence at five years was higher among patients with macroprolactinomas and those with microprolactinomas who had small remnant tumors visible on MRI at the time of treatment withdrawal than among patients whose MRI scans showed no evidence of tumor at the time of withdrawal (patients with macroprolactinomas, 78 percent vs. 33 percent, P=0.001; patients with microprolactinomas, 42 percent vs. 26 percent, P=0.02). Cabergoline can be safely withdrawn in patients with normalized prolactin levels and no evidence of tumor. However, because the length of follow-up in our study was insufficient to rule out a delayed increase in the size of the tumor, we suggest that patients be closely monitored, particularly those with macroprolactinomas, in whom renewed growth of the tumor may compromise vision. Copyright 2003 Massachusetts Medical Society

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Author and article information

Contributors

Stephen L Atkin

Journal

Journal ID (nlm-ta): Arab J Urol

Journal ID (iso-abbrev): Arab J Urol

Title: Arab Journal of Urology

Publisher: Elsevier

ISSN (Print): 2090-598X

ISSN (Electronic): 2090-5998

Publication date PMC-release: 16 November 2017

Publication date Collection: March 2018

Publication date (Electronic): 16 November 2017

Volume: 16

Issue: 1

Pages: 44-52

Affiliations

[a ]Hamad Medical Corporation, Doha, Qatar

[b ]Weill Cornell Medicine Qatar, Doha, Qatar

Author notes

[* ]Corresponding author. Fax: +974 44928422. sla2002@ 123456qatar-med.cornell.edu

Article

Publisher ID: S2090-598X(17)30108-0

DOI: 10.1016/j.aju.2017.10.002

PMC ID: 5922222

PubMed ID: 29713535

SO-VID: 6c7dcc78-3ec9-4cfe-af55-fe4963f2e313

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 21 August 2017

Date revision received : 4 October 2017

Date accepted : 7 October 2017

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Hyperprolactinaemia in male infertility: Clinical case scenarios

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Abstract

Objective

Methods

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Conclusion

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ScienceOpen Clinical Case Reports Collection

Most cited references 36

Advances in the treatment of prolactinomas.

Male factor infertility: evaluation and management.

Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia.

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Cited by 23

Most referenced authors 754