トルコ鞍空洞症に伴う高プロラクチン血症が原因と考えられた男性不妊症の1例

Abstract

A 41-year-old male with the chief complaint of infertility was referred to our hospital. He presented withmild erectile dysfunction and reduced shaving frequency. Semen analysis indicated a decreased semen volume in addition to a low sperm count and motility. Hormone evaluation revealed the following details : follicle stimulating hormone (FSH) 1.7 mIU/ml (range 2.0-8.3 mIU/ml), luteinizing hormone (LH) 0.9 mIU/ml (range 0.8-5.7 mIU/ml), testosterone 86.6 ng/dl (range 225.0-1, 039 ng/dl), and prolactin (PRL) 242.0 ng/ml (range 3.6-12.8 ng/ml). Magnetic resonance imaging (MRI) of the patient's head showed empty sella turcica. He was diagnosed with acquired hypogonadotropic hypogonadism due to hyperprolactinemia. We suspected that the hyperprolactinemia was due to the pituitary lesion, although the possibility of coexisting pituitary microadenoma could not be discarded. Based on the diagnosis, cabergoline therapy was started. Four months after initiation of cabergoline therapy, the patient's hormone levels and semen parameters normalized, followed by improvement in his clinical symptoms. Furthermore, his wife spontaneously conceived.