鞍区占位继发男性性腺功能减退症22例临床分析

Secondary male hypogonadism induced by sellar space-occupying lesion: Clinical analysis of 22 cases

目的:分析鞍区占位病变继发男性性腺功能减退症的临床特点,探索其病因,提高其诊治水平。方法:通过回顾22例鞍区占位病变继发男性性腺功能减退症患者的临床资料,结合文献,分析该病的临床表现、发生原因和治疗原则。22例患者术前出现性腺功能减退症者为A组,术后及放疗后出现者为B组。按内分泌治疗药物分为Andriol组和h CG组。结果:A组患者鞍区占位平均径线[(2.35±0.71)cm]显著大于B组[(1.83±0.36)cm](P<0.05),泌乳素腺瘤的发生率A组也显著高于B组(60%vs 0,P<0.01)。B组患者接受手术及放疗后,黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)水平均明显下降(P均<0.01)。使用十一酸睾酮胶丸和h CG治疗后,Andriol组和h CG组患者T、国际勃起功能指数-5(IIEF-5)评分均较术前明显提高[T,Andriol组:(9.40±2.43)nmol/L vs(2.71±1.39)nmol/L,h CG组:(10.65±2.32)nmol/L vs(3.23±1.53)nmol/L;IIEF-5,Andriol组:(14.50±3.62)分vs(5.00±2.61)分,h CG组:(15.07±3.27)分vs(5.36±1.82)分](P均<0.01);其中以发育迟缓就诊的患者治疗后出现睾丸增大、阴毛生长等青春期发育征象。h CG组睾丸体积明显增大(P<0.01),并有7例产生精子,产生精子者其睾丸初始体积[(11.5±2.3)ml]明显大于未产生精子者[(7.5±2.3)ml](P<0.01)。Andriol组治疗前后睾丸体积无统计学差异,无产生精子的患者。结论:手术和放疗对垂体组织的损伤、病变的占位性效应和高泌乳素血症是鞍区占位性病变引起性腺功能减退的可能原因。十一酸睾酮和h CG均可明显提高T水平和改善勃起功能障碍的症状。十一酸睾酮胶丸治疗对精子生成无治疗效应。

Objective：To analyze the clinical characteristics of secondary male hypogonadism induced by sellar space-occupying lesion,explore its pathogenesis,and improve its diagnosis and treatment. Methods： We retrospectively analyzed the clinical data about 22 cases of secondary male hypogonadism induced by sellar space-occupying lesion,reviewed related literature,and investigated the clinical manifestation,etiological factors,and treatment methods of the disease. Hypogonadism developed in 10 of the patients before surgery and radiotherapy（ group A） and in the other 12 after it（ group B）. The patients received endocrine therapy with Andriol（n = 7） or h CG（n = 15）. Results： The average diameter of the sellar space-occupying lesions was significantly longer in group A than in B（[2. 35 ± 0. 71] vs [1. 83 ± 0. 36] cm,P 〈0. 05） and the incidence rate of prolactinomas was markedly higher in the former than in the latter group（60% vs 0,P 〈0. 01）. The levels of lutein hormone（ LH）,follicle stimulating hormone（ FSH） and testosterone（ T） were remarkably decreased in group B after surgery and radiotherapy（ P 〈0. 01）. Compared with the parameters obtained before endocrine therapy,all the patients showed significant increases after intervention with Andriol or h CG in the T level（[0. 78 ± 0. 40]vs [2. 71 ± 0. 70]ng/ml with Andriol; [0. 93 ± 0. 44]vs [3. 07 ± 0. 67]ng/ml with h CG） and IIEF-5 score（5. 00± 2. 61 vs 14. 50 ± 3. 62 with Andriol; 5. 36 ± 1. 82 vs 15. 07 ± 3. 27 with h CG）（ all P 〈0. 01）. The testis volume increased and pubic hair began to grow in those with hypoevolutism. The patients treated with h CG showed a significantly increased testis volume（ P 〈0. 01） and sperm was detected in 7 of them,whose baseline testis volume was markedly larger than those that failed to produce sperm（[11. 5 ± 2. 3]vs [7. 5 ± 2. 3]ml,P 〈0. 01）. Those treated with Andriol exhibited no significant difference in the testis volume before and after intervention and produced no sperm,either. Conclusion： Hypothyroidism might be attributed to surgery- or radiotherapy-induced damage to the pituitary tissue,space-occupying effect of sellar lesion,and hyperprolactinemia. Both Andriol and h CG can improve the T level and erectile function,but the former does not help spermatogenesis.