Role of secondary empty sella syndrome in the development of erectile dysfunction
Objective: to assess the role of secondary empty sella syndrome (ESS) in the development of erectile dysfunction (ED). Patients and methods. This study included 104 patients with hormone-related ED aged between 23 and 57 years. The severity of ED and androgen deficiency were assessed using the AMS questionnaire and Morley questionnaire. Patients also underwent echo Doppler ultrasound of the penis with intracavernous pharmacological tests, hormone measurement, and magnetic resonance imaging (MRI) of the brain (in patients with suspicion of neuroendocrine disorders). None of the patients have been previously diagnosed with ESS and, therefore, none of them have received systemic therapy with drugs that can potentially cause hypopituitarism (i.e. anabolic steroids); the diagnosis was established occasionally during the examination for ED. We did not assess the fertility because the majority of patients were married and had children; their main complaint was decreased erectile function. Results. All participants had signs of decreased erectile function. Fifty-seven (54.8%) out of 104 patients were found to have ESS detected by MRI. Twenty-two patients (22.1%) had changes in the ocular fundus indicating increased intracranial pressure. Forty-six patients (44.2%) were obese and demonstrated impaired glucose tolerance and insulin resistance. Participants with intracranial hypertension received osmotic diuretics. Patients with ED and hormonal disorders received replacement therapy (HCG plus testosterone). Participants with hyperprolactinemia were treated with dopamine agonists (doses were calculated individually) and regularly tested for their prolactin levels. The therapy was effective in all participants; they reported increased frequency and duration of intercourses. Follow-up Doppler ultrasound examinations of the penis demonstrated improved regional hemodynamics. However, the symptoms were reversible with cessation of therapy. Conclusion. Our results suggest significant role of ESS in the pathogenesis of ED. Of note, in the majority of cases, ESS is an incidental X-ray finding, which is often accompanied by impaired glucose tolerance, obesity, and metabolic syndrome. Nevertheless, ESS should be accurately diagnosed and properly treated (when necessary), because it is characterized by a number of clinical manifestations and hormonal changes, which can potentially lead to negative consequences. Appropriate diagnosis, treatment, and monitoring requires a multidisciplinary approach involving several healthcare professionals, including endocrinologists, neurologists, and ophthalmologists.