Diagnostics and the combined medical tactics at patients with erectile dysfunction at a empty sella syndrome

Abstract

Background. The study of hormonal status in patients with erectile dysfunction (ED), especially the older and senior age groups, is most often limited to the evaluation of testosterone fractions

Aim: demonstrate the effectiveness of transcranial magnetotherapy in a combined treatment regimen for patients with «empty sella syndrome” (ESS).

Methods. Results of diagnostics examination and treatment of 118 patients with the ED hormonal form at the age of 23–57 are studied. The expressiveness of disturbances of erectile function and signs of androgenic deficiency are estimated by means of questionnaires of AMS and a scale of Morley, the penil color flow Doppler ultrasound with intracavernous pharmacological tests is carried out, the hormonal status is estimated. At suspicion of neuroendocrine pathology MRI of the brain is executed. At all examined patients signs of decrease erectile functions are revealed. In 62 (52.5%) observations during MRI the picture of ESS is revealed. In 22 (18.6%) observations the changes of an eyeground demonstrating increase in intracranial pressure takes place, however loss of fields of vision is not observed in any of patient. Persistent headaches are noted in 19 (16.1%) observations. In 46 (39%) observations at patients with considerable obesity signs of disturbance of tolerance to glucose and insulin resistance are revealed. To patients hormone replacement therapy is appointed, at identification of a hyperprolactinemia agonists of dopamine receptors in an individual dosage under control of level of prolactin are used, therapy of intracranial hypertensia is carried out. In complex therapy transcranial magnetotherapy is used.

Results. Therapy is effective, during treatment increase in frequency and duration of sexual intercourses is noted. At control Doppler researches of a penis improvement of a regional hemodynamics is noted. Cancellation of medicines lead to resuming of symptomatology of a disease.

Conclusion. Thus, the research shows powerful value of a syndrome of ESS in a pathogeny of ED demanding multidisciplinary approach with involvement of adjacent specialists — endocrinologists, neurologists and ophthalmologists. It is important to note that ESS, in most cases, is an accidental tomographic finding, at the same time often is followed by disturbance of tolerance to glucose, obesity, a metabolic syndrome. Introduction in complex therapy of transcranial magnetic influence substantially improves results of treatment of this category of patients, as due to additional stimulation of synthesis of pituitary hormones, and cerebral decompression.

Keywords

erectile dysfunction / sempty sella syndrome / morbid obesity / replacement hormonal therapy / transcranial magnetic stimulation

References

[1] Urologiia. Rossiiskie klinicheskie rekomendatsii. Ed by Iu.G. Alyaev, P.V. Glybochko, D.Iu. Pushkar'. Moscow: Medforum; 2018. 544 р. (In Russ).

[2] Урология. Российские клинические рекомендации / Под ред. Ю.Г. Аляева, П.В. Глыбочко, Д.Ю. Пушкаря. ― М.: Медфорум, 2018. ― 544 с.

[3] European Association of Urology. Sexual and Reproductive Health: guidlines. URL: https://uroweb.org/guideline/sexual and reproductive health

[4] Клинические рекомендации Европейской ассоциации урологов. URL: https://uroweb.org/guideline/sexual and reproductive health.

[5] Glybochko PV, Alyaev IuG, Chalyi ME, Akhvlediani ND. Polovye rasstroistva u muzhchin. Moscow: GEOTAR-Media; 2012. 112 р. (In Russ).

[6] Глыбочко П.В., Аляев Ю.Г., Чалый М.Е., Ахвледиани Н.Д. Половые расстройства у мужчин. ― М.: ГЭОТАР-Медиа, 2012. ― 112 с.

[7] Shakhov BE, Krupin VN. Diagnostika erektil'noi disfunktsii. N.-Novgorod: NizhGMA; 2009. 188 р. (In Russ).

[8] Шахов Б.Е., Крупин В.Н. Диагностика эректильной дисфункции. ― Н.-Новгород: НижГМА, 2009. ― 188 с.

[9] Zhukov OB. Diagnostika erektil'noi disfunktsii. Klinicheskoe rukovodstvo. Moscow: Binom; 2008. 184 р. (In Russ).

[10] Жуков О.Б. Диагностика эректильной дисфункции. Клиническое руководство. ― М.: Бином, 2008. ― 184 с.

[11] Markosyan TG, Korchazhkina NB, Nikitin SS, Bodrov AV. Neurofunctional diagnosis and treatment of erectile dysfunction. Urology and andrology. 2016;4(2):11–16. (In Russ). doi: 10.20953/2307-6631-2016-2-11-16.

[12] Маркосян Т.Г., Корчажкина Н.Б., Никитин С.С., Бодров А.В. Нейрофункциональная диагностика и лечение эректильной дисфункции // Вопросы урологии и андрологии. ― 2016. ― Т.4. ― №2. ― С. 11–16. doi: 10.20953/2307-6631-2016-2-11-16.

[13] Endokrinologia. Rukovodstvo dlia vrachei. Ed by V.V. Potemkin. Moscow: MIA; 2013. 776 р. (In Russ).

[14] Эндокринология. Руководство для врачей / Под ред. В.В. Потемкина. ― М.: МИА, 2013. ― 776 с.

[15] Dedov II, Mel'nichenko GA, Fadeev VV. Endokrinologiia. Moscow: Meditsina; 2000. 630 р. (In Russ).

[16] Дедов И.И., Мельниченко Г.А., Фадеев В.В. Эндокринология. ― М.: Медицина, 2000. ― 630 с.

[17] Markosyan TG, Korchazhkina NB. Sindrom "pustogo turetskogo sedla" v etiopatogeneze erektil'noi disfunktsii. (Conference proceedings) Materialy XIII s"ezda, XVII Kongressa ROU. Moscow; 2017. Р. 274. (In Russ).

[18] Маркосян Т.Г., Корчажкина Н.Б. Синдром «пустого турецкого седла» в этиопатогенезе эректильной дисфункции / Материалы XIII Съезда, XVII Конгресса РОУ. ― М., 2017. ― С. 274.

[19] Markosyan TG, Nikitin SS, Markosyan AG. Individual properties of therapeutic and diagnostic tactics applied in patients suffering from erectile dysfunction in combination with "empty sella syndrome". Int J Pharm Res. 2019;11(1). doi: 10.31838/ijpr/2019.11.01.119.

[20] Markosian TG, Nikitin SS, Markosian AG. Individual properties of therapeutic and diagnostic tactics applied in patients suffering from erectile dysfunction in combination with "empty sella syndrome". Int J Pharm Res. 2019;11(1). doi: 10.31838/ijpr/2019.11.01.119.

[21] Arapova SD, Dedov II. Klinicheskaia neiroendokrinologiia. Moscow: UP Print; 2011. 343 р. (In Russ).

[22] Арапова С.Д., Дедов И.И. Клиническая нейроэндокринология. ― М.: УП Принт, 2011. ― 343 с.

[23] Markosyan TG, Bolevich SS, Bolevich SB. Role of secondary empty sella syndrome in the development of erectile dysfunction. Urology and Andrology. 2018;6(3):43–50. doi: 10.20953/2307-6631-2018-3-43-50.

[24] McLachlan MS, Williams ED, Doyle FH. Applied anatomy of the pituitary gland and fossa: a radiological and histopathological study based on 50 necropsies. Br J Radiol. 1968;41(490):782–788. doi: 10.1259/0007-1285-41-490-782.

[25] Bergland RM, Ray BS, Torack RN. Anatomical variations in the pituitary gland and adjacent structures in 225 human autopsy cases. J Neurosurg. 1968;28(2):93–99. doi: 10.3171/jns.1968.28.2.0093.

[26] Jordan RM, Kendall JW, Kerber CW. The primary empty sella syndrome: analysis of the clinical characteristic, radiographic features, pituitary function and cerebral fluid adeno-hypophysial concentrations. Am J Med. 1977;62(4):569–580. doi: 10.1016/0002-9343(77)90441-7.

[27] Bianconcini G, Bragagni G, Bianconcini M. [Primary empty sella syndrome. Observations on 71 cases. (In Italian)]. Recent Prog Med. 1999;90(2):73–80.

[28] Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 2002:59(10):14921495. doi: 10.1212/01.wnl.0000029570.69134.1b.

[29] Jockenhövel F. Male hypogonadism. UNI-MED Germany; 2004. 188 р.

[30] Kirkpatrick PJ, Meyer T, Sarkies N, et al. Papilloedema and visual failure in a patient with nocturnal hypoventilation. J Neurol Neurosurg Psychiatry. 1994;57(12):1546–1547. doi: 10.1136/jnnp.57.12.1546.

[31] Сhiloiro S, Tartaglione T, Angelini F, et al. An overview of diagnosis of primary autoimmune hypophysitis in a prospective single-center experience. Neuroendocrinology. 2017;104(3):280–290. doi: 10.1159/000446544.

[32] Gallardo E, Schachter D, Caceres E, et al. The empty sella: results of treatment in 76 successive cases and high frequency of endocrine and neurological disturbances. Clin Endocrinol (Oxf). 1992;37(6):529–533. doi: 10.1111/j.1365-2265.1992.tb01484.x.

[33] Delgado-Hernández A, Verduzco-Mendoza A, Luna-Reyes FA, et al. [Analysis of the joint and a posteriori probability between primary empty sella, its comorbidities and audiovestibular pathology. (In Spanish)]. Cir Cir. 2015;83(6):459–466. doi: 10.1016/j.circir.2015.04.031.

[34] Guitelman M, Basavilbaso GN, Vitale M, et al. Primary empty sella(PES): a review of 175 ases. Pituitary. 2013;16(2):270–274. doi: 10.1007/s11102-012-0416-6.

[35] Degli Uberti EC, Teodori V, Trasforini G, et al. [The empty sella syndrome. Clinical radiological and endocrinologic analysis in 20 cases. (In Italian)]. Minerva Endocrinol. 1989;14(1):1–18.

[36] Del Monte P, Foppiani L, Cafferata C, et al. Primary 'empty sella' in adults: endocrine findings. Endocr J. 2006;53:803–809. doi: 10.1507/endocrj.k06-024.

RIGHTS & PERMISSIONS

Eco-Vector