Erektil disfonksiyonun değerlendirilmesinde hormonal incelemenin gerekliliği

Year 2018, Volume: 25 Issue: 4, 356 - 360, 01.12.2018

Mehmet Sarıer , Ahmet Soylu , Can Baydinç

https://doi.org/10.17343/sdutfd.368786

Cited By: 1

Abstract

Amaçlar:  Erektil
Disfonksiyon nedeniyle başvuran hastada yapılacak ilk incelemede rutin hormonal
değerlendirmenin yapılıp yapılmaması tartışmalıdır. Bu çalışmada kliniğimize
başvuran ve hormonal inceleme yapılan hastalara bu incelemelerin katkısı araştırıldı.

Yöntem ve gereçler: Pokliniğimize
başvuran ve hormonal değerlendirme düşünülen hastalarda FSH, LH, Prolaktin ve
Testosteron seviyelerinden en az ikisine bakılarak incelemeler yapıldı.
Hormonal bozukluk oranları tespit edilerek bu bozukluların hasta yaşı ile
korele olup olmadığına bakıldı. Ayrıca bu değerlendirmeler sonucunda tedavide
farklı bir uygulamanın yapılıp yapılmadığı tespit edildi.

 Bulgular: Ortalama yaşı 46,1 olan 356
hastanın 227’sine (%63.8) hormonal inceleme yapıldı. FSH yüksekliği % 9.5
(20/221), LH yüksekliği %7.1 (16/224), prolaktin yüksekliği %4.7 (10/211) ve
testosteron düşüklüğü %3.7 (7/191) hastada tespit edildi. FSH ve LH ile yaş
arasında anlamlı pozitif korelasyon, prolaktin ile yaş arasında negatif
korelasyon görülürken testesteron ile yaş arasında korelasyon tespit edilmedi.
Prolaktin yüksekliği olan 10 hastanın 1 tanesi daha önceden hipofiz adenomu
tanısı almış ve tedavi edilmekteydi. Diğer 9 hastada prolaktin değerleri normal
sınırın 2 katını geçmediğinden endokrinoloji bilim dalı tarafından ek incelemeye
gerek görülmedi. Testosteron düşüklüğü olan 7 hastadan libido azalması olan 2
tanesine testosteron replasmanı yapılırken diğer 5 tanesine gerek görülmedi ve
tüm hastalara erektil disfonksiyona yönelik tedaviler uygulandı. 

Sonuçlar: Bu bulgular
erektil disfonksiyon nedeniyle başvuran bir hastada yapılacak ilk incelemede
hormonal incelemenin tedaviye ek katkısının çok olmayacağını göstermektedir.
Hormonal incelemeler iyi bir anemnez ve fizik muayeneyi takiben sadece gerekli
olgularda istenmelidir. 

Keywords

Erektil disfonksiyon, hormon, testosteron

Necessity of endocrine screening in men with erectile dysfunction

Abstract

OBJECTIVES: It is an issue
of debate whether or not to perform hormonal testing as a first-line
investigation in patients with erectile dysfunction. This study aimed to assess
the contribution of hormonal testing to the diagnostic investigations of
patients who present with erectile dysfunction.

 METHODS:
Investigations were performed in patients who applied to our andrology
clinic and in whom hormonal causes were suspected, by looking at least two of
the FSH, LH, prolactin and testosterone levels. The rates of hormonal
disturbances and their correlation with age were determined. Additionally, whether
any modification was performed or not according to the results of these tests
was noted.

RESULTS: Hormonal investigation was performed in 227(63.8%) of 356 patients. The
increased levels of FSH,LH,prolactin and decreased level of testosterone were
seen in 9.5%(20/221),7.1% (16/224),4.7%(10/211) and 3.7%(7/191) of the
patients.There was a positive correlation between FSH and LH and age,a negative
correlation between prolactin and age,and no correlation between testosterone
and age. One of the 10 patients with prolactin increase had been diagnosed and
been receiving treatment for hypophysis adenoma. Since the level of prolactin
was not twice the normal level no further examination was requested in the
remaining 9 patients by the endocrinologists. Testosterone replacement was
given in two of 7 patients with decreased libido. In the remaining 5 patients
no replacement was needed.

 CONCLUSIONS:
Our findings indicate that performing the hormonal investigation as a first
line investigation in an erectile dysfunction patient does not contribute to
the treatment additionally. Hormonal investigations should be performed after
detailed history and physical examination and only in necessary cases.

Keywords

Erectile dysfunction, hormone, testosterone

References

• Referans1. Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urology 2010;57:804-14.
• Referans2. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKilay JB, Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Jurol 1994;151(1):54-61
• Referans3. Bella AJ, Lue TF. Erkeklerde Cinsel İşlev Bozukluğu In Smith Genel Üroloji 17. Türkçe Baskı İstanbul: Nobel Tıp Kitabevleri 2004, s 594.
• Referans4. Acar D, CAyan S, Bozlu M, Akbay E.: Is routine hormonal measurement necessary in initial evaluation of men with erectile dysfunction? Arch Androl. 2004 Jul-Aug;50(4):247-53.
• Referans5. Tom F. Lue. Physiology of penile erection and pathophysiology of erectile dysfunction an priapism. Walsh PC, Retik AB, Vaughan ED, Wein AJ. Campbell’s Urology. Saunders, Philederphia 2002. Chapter 45, pp 1607-1608
• Referans6. Buvat J, Carson CC, Gooren LJ, Jarow J, Raifer J, Vermeulen A: Recommendations of the 1st Intenational Consultation on Erectile Dysfunction. In Jardin A, Wagner G, Khoury S, Giuliano F, Goldstein I, Padma Nathan H, Rosen R (eds): Endocrine and metabolic aspect including treatment. Health Publication Ltd, Plymouth,2000 pp205-240
• Referans7. Papagiannopoulos D, Nehra A, Khare N. Evaluation of young men with organic erectile dysfunction. Asian J Androl. 2015;17(1):11
• Referans8. AACE Hypogonadism Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients: 2002 update. Endocr Pract 2002; 8: 439-456
• Referans9. Kupelian V, Shabsigh R, Travison TG, Page ST, Araujo AB, McKinlay JB. Is there a relationship between sex hormones and erectile dysfunction? Results from the Massachusetts Male Aging Study. J Urology 2006;176:2584-8
• Referans10. Raijfer J. Relationship between testosterone and erectile dysfunction. Rev Urol 2000;2:122-8
• Referans11. Mulligan T, Schmitt B: Testesterone for erectile failure. J Intern Med 1993;8:517-521
• Referans12. Johnson AR, Jarrow JP: Is rutin endocrine testing of impotent men necessary? J Urol 1992; 147: 1542-1543
• Referans13. Buvat J, Lamire A: Endocrine screening in 1022 men with erectile dysfunciton: clinical significance and cost-effective strategy . J Urol1997; 158: 1764-1767
• Referans14. Acar D, Cayan S, Bozlu M, Akbay E: Is routine hormonal measurement necessary in initial evaluation of men with erectile dysfunction? Arch Androl. 2004; 50(4): 247-253
• Referans15. Buvat, J.: Hormones et comportement sexuel de I’homme. Donnees physiologiques et physio-pathologiques. Contr. Fert. Sex., 24: 767, 1996
• Referans16. Vermeulen A, Kaufman JM, Giagulli VA: Influence of some biological indices on sex hormone binding globulin and androgen levels in aging and obese males J Clin Endocrinol Metab 1996; 81:1921-1927
• Referans17. Maatman TJ, Montague DK: Routine endocrine screening in impotence. Urol 1986; 27: 499-502
• Referans18. Gonzales-Cadavit NF, Swerdoff RS, Lemmi CAE, Rajfer J: Expression of androgen receptor gene in rat penile tissue and cells during sexual maturation. Endocrinology 1991; 129: 1671-1678
• Referans19. Bodie J, Lewis J, Schow D, Monga M. Laboratory evaluations of erectile dysfunction: an evidence based approach. J Urology 2003;169:2262-4
• Referans20. Apkunonu, B.E., Mutgi, A.B., Federman, D.J., York, J., Woldenberg, L.S.:Routine prolactine measurement is not necessary in the initial evaluation of male impotence. J Gen. Intern. Med., 1994; 9: 336-338
• Referans21. Netto Junior NR, Claro J de A: The impotence of hyperprolcatinemia in impotence. Rev Paul Med 1993; 111: 454-455
• Referans22. Çalışkan S., Koca O., Ozturk M. et al. :Hormonal evaluation in erectile dysfunction. Turkish Journal of Urology 2012; 38(1): 19-22
• Referans23. Margolese HC. The male menopouse and mood: testosterone decline and depression in the aging male-is there a link? J Geriatr Psychiatr Neurol 2000;13:93-101.