Michele De Rosa

Hyperprolactinemia in men: clinical and biochemical features and response to treatment.

Hyperprolactinemia induces hypogonadism by inhibiting gonadotropin-releasing hormone pulsatile secretion and, consequently, follicle-stimulating hormone, luteinizing hormone, and testosterone pulsatility. This leads to spermatogenic arrest, impaired motility, and sperm quality and results in morphologic alterations of the testes similar to those observed in prepubertal testes. Men with hyperprolactinemia present more frequently with a macroadenoma than a microadenoma. Symptoms directly related to hypogonadism are prevalent. In men hypogonadism leads to impaired libido, erectile dysfunction, diminished ejaculate volume, and oligospermia. It is present in 16% of patients with erectile dysfunction and in approx 11% of men with oligospermia. Treatment with bromocriptine or cabergoline (CAB) is effective in men with prolactinomas, with a response that is in general comparable to treatment in women. Seminal fluid abnormalities rapidly improve with CAB treatment, while other dopaminergic compounds require longer periods of treatment. Moreover, to improve gonadal function in men, the integrity of the hypothalamic-pituitary-gonadal axis is necessary. New promising data indicate that a substantial proportion of patients with either micro- or macroprolactinoma do not present hyperprolactinemia after long-term withdrawal from CAB. Whether this corresponds to a definitive cure is still unknown, but treat-ment withdrawal should be attempted in patients achieving normalization of prolactin levels and disappearance of tumor mass to investigate this issue.

PRL Secreting Adenomas in Male Patients

Prolactinomas are the most frequent pituitary tumors and their frequency varies with age and sex, occurring most frequently in females between 20–50 yr-old. In men, hyperprolactinaemia is often present for many years without symptoms, as generally the most important symptoms are the decrease in libido and/or sexual potency both underestimated by the majority of the patients. Prolactin (PRL) plays a role in the process of spermatogenesis, and normal serum PRL levels are required for normal testicular function. On the other hand, hyperprolactinaemia has multiple negative effects on the gonadal axis. As a consequences hyperprolactinemic males show alteration of sexual potency and seminal fluid quality. Cabergoline treatments is able to induce normalization of PRL levels and a reduction of tumor mass in the majority of patients and consequently restoring the normal semen quality and ameliorating the quality of life of men with pituitary PRL-secreting adenoma.

Correlation between Seminal Carnitine and Functional Spermatozoal Characteristics in Men with Semen Dysfunction of Various Origins

AbstractBackground and objective: L-carnitine is an essential molecule involved in mitochondrial metabolism, controlling the transport of acetyl and acyl groups across the mitochondrial inner membrane. Carnitine and acetylated carnitine (L-acetylcarnitine) are found in high concentrations in the epididymis, where they also act as antioxidants, protecting spermatozoa against damage caused by reactive oxygen species. In this open study we investigated the correlation between seminal carnitine levels and spermatozoal function, and the effect of combined L-carnitine + L-acetylcarnitine therapy, in infertile men. Patients and methods: 170 infertile men were enrolled in this study. Patients were divided into those with a total sperm motility below the normal WHO range (<50% motility, group 1 [n = 102]) and those with total sperm motility within the normal range (>=50% motility, group 2 [n = 68]). Patients in group 1 were further divided into two groups: those with primary or secondary azoospermia (1B [n = 36]), and those without (1A [n = 66]). Patients in group 1A received L-carnitine 1 g/day and L-acetylcarnitine 500mg twice daily for 6 months. Seminal carnitine levels were measured and correlated with sperm count and motility, eosin test, hypo-osmotic swelling test, acridine orange test for sperm nuclear DNA integrity and sperm kinetics evaluated by computer-assisted sperm analysis in all patients. Results: There was a significant correlation between seminal carnitine concentration and sperm concentration, total sperm count, sperm total motility, rapid forward progression, live sperm count, membrane function, nuclear DNA integrity, capacity for cervical mucus penetration, linearity of spermatic movement, and amplitude of lateral sperm head movement (all p < 0.0001) in the entire study population. In group 1A, there was a significant increase in total motility, live sperm count, membrane integrity and linearity of spermatic movement after 3 and 6 months of L-carnitine/L-acetylcarnitine treatment, and in capacity for cervical mucus penetration after 6 months of treatment, compared with baseline. Conclusion: Seminal carnitine concentration may be an appropriate marker of sperm and epididymal function. L-carnitine/L-acetylcarnitine treatment may be an effective therapy to improve mainly functional seminal parameters.

Somatostatin analogs in treatment of non-growth hormone-secreting pituitary adenomas.

Besides well-known effects in GH-secreting adenomas, somatostatin analogs such as octreotide and lanreotide have been used in TSH-secreting adenomas and in the so-called clinically nonfunctioning adenomas. The rationale for their use is based on the evidence that both these tumor types express large amounts of somatostatin receptor subtypes 2 and 5, which are preferentially bound by octreotide and lanreotide. However, whether in TSH-secreting adenomas the results are excellent in the nonfunctioning type, the results are controversial. Some preliminary results showing a very rapid recovery of the visual field have not been confirmed subsequently. No evident effect of tumor shrinkage has been reported. At present, the use of somatostatin analogs in clinically nonfunctioning adenomas is questioned.

The treatment with cabergoline for 24 month normalizes the quality of seminal fluid in hyperprolactinaemic males

Background  Alterations of sperm number and motility are found in hyperprolactinaemic men. Cabergoline treatment reverses alterations in semen. No information is currently available on the quality of seminal tests in hyperprolactinemia in response to cabergoline treatment.

High serum thyroglobulin levels: Diagnostic indicators in patients with metastases from unknown primary sites

Patients with metastases from differentiated thyroid carcinoma have a good chance of long‐term survival when the diagnosis is prompt and appropriate therapy is applied early. This is also true for patients with metastases in the bone, taking into account that an appropriate therapy, usually 131‐I, may be palliative in some cases. This study investigates whether serum thyroglobulin (Tg) measurement in patients with cold thyroid nodule and metastases from an unknown primary site could help identify a differentiated thyroid carcinoma. The results obtained show that Tg measurements is a useful adjunctive test when used with fine‐needle aspiration biopsy. In particular, very high Tg levels point to metastatic thyroid cancer, whereas lower levels do not help determining whether metastatic cancer is of thyroid origin or not.

Male Hypogonadism Resulting From Disorders of the Pituitary and Suprasellar Region

The primary regulator of testicular function is gonadotropin-releasing hormone (GnRH) that is secreted episodically by hypothalamic neurons into the portal vascular system. GnRH stimulates the synthesis and secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are produced by gonadotrophs of the anterior pituitary. LH stimulates testosterone synthesis after binding to specific receptors on Leydig cells, whereas Sertoli cells in the seminiferous tubules are the primary target of FSH (1, 2). Accordingly, mass lesions and other disorders of the suprasellar region or pituitary that disrupt GnRH or LH/FSH production result in impaired testicular function that is designated hypogonadotropic hypogonadism because of the deficiency of LH and FSH. These disorders are the subject of this chapter.

A new enrichment diagnostic platform for semen culture

Urogenital bacterial infections have been described in literature as a potential cause of infertility. For the consequences that a failure in diagnosis could have on the evolution of male urogenital infectious disease, an accurate microbiological procedure to investigate the bacterial species composition of seminal fluid plays a crucial role to better understand the eventual correlation with infertility. In order to improve the quality of semen culture investigations, we have developed a new enrichment diagnostic platform. Semen samples of 540 infertile men were simultaneously analyzed using the standard microbiological semen culture method and an alternative new experimental technique (Brain Heart Infusion broth, BHI, enrichment). Our results established the possibility to apply BHI enrichment to detect bacteria from semen samples with higher sensitivity (100%) and negative predictive value (100%) than the standard technique.

Terapia ormonale del transessualismo

RiassuntoIl transessualismo è un disordine psico-sessuale, generalmente non associato ad anomalie somatiche o genetiche, per il quale un individuo biologicamente appartenente ad un sesso sceglie di vivere come appartenente al sesso opposto. Egli vuole essere tale sia sotto il profilo anatomico e fisiologico che sociale e professionale e ritiene i suoi rapporti omosessuali come normali rapporti eterosessuali. Esistono due tipi di transessuali che chiedono l’adeguamento al loro sesso psicologico. I transessuali maschi, con cariotipo 44A XY, che chiedono una femminilizzazione del loro fenotipo ed i transessuali femmine, con cariotipo 44A XX, che chiedono una mascolinizzazione del loro corpo.