IIEF-15 Summary sheet.

PurposeHypogonadism, presenting with low libido, erectile dysfunction, and gynecomastia, frequently occurs in men with hyperprolactinemia, typically characterized by elevated serum prolactin, suppressed gonadotropins, and low testosterone. However, we identified a rare subset of patients who presented with normal testosterone levels, but whose clinical profiles were poorly defined.MethodsA retrospective analysis of medical records was conducted on 23 men diagnosed with idiopathic hyperprolactinemia and normal testosterone levels between 01/07/2019 and 01/12/2024. Baseline clinical characteristics, hormone levels, pituitary gland dimensions (as measured by MRI-derived pituitary height), and responses to medical treatments (bromocriptine or cabergoline) were evaluated.ResultsThe mean age at diagnosis was 30.91 ± 7.66 years (range: 20–50). Mean serum prolactin at presentation was 38.22 ± 30.68 ng/mL (range: 20.00–170.93), and mean pituitary height was 6.40 ± 0.97 mm. Primary complaints at diagnosis included low libido, gynecomastia, impotence, and erectile dysfunction. Eighteen patients received bromocriptine, whereas five patients received cabergoline. After an average treatment duration of 7.83 ± 6.97 months (range: 1–29 months), prolactin levels normalized in all patients, pituitary height was significantly reduced to 4.39 ± 1.37 mm, and most patients reported notable clinical improvements, particularly in sexual function.ConclusionIdiopathic hyperprolactinemia-associated hypogonadism can occasionally present with normal testosterone levels, emphasizing the importance of clinical vigilance beyond standard hormonal assessments. Pituitary height reduction may serve as an important diagnostic marker and indicator of treatment effectiveness. Medical treatment, including bromocriptine or cabergoline, with a possible preference for cabergoline based on clinical considerations, can effectively normalize hormone levels and significantly improve clinical symptoms.研究背景：高催乳素血症（hyperprolactinemia）男性常并发性腺功能减退症（hypogonadism），临床表现为性欲低下、勃起功能障碍（erectile dysfunction）及男性乳房发育症（gynecomastia），典型特征为血清催乳素升高、促性腺激素（gonadotropins）受抑及睾酮（testosterone）水平降低。然而本研究发现一类罕见的患者亚群，其睾酮水平正常，但临床特征尚未明确阐明。 研究方法：本研究对2019年7月1日至2024年12月1日期间确诊为特发性高催乳素血症（idiopathic hyperprolactinemia）且睾酮水平正常的23例男性患者的病历资料开展回顾性分析。评估内容包括患者基线临床特征、激素水平、垂体尺寸（通过磁共振成像（MRI）测量的垂体高度）以及对药物治疗（溴隐亭（bromocriptine）或卡麦角林（cabergoline））的应答情况。 研究结果：患者确诊时的平均年龄为30.91±7.66岁（年龄范围20~50岁）。就诊时血清催乳素平均水平为38.22±30.68 ng/mL（范围20.00~170.93 ng/mL），平均垂体高度为6.40±0.97 mm。患者确诊时的主要主诉包括性欲低下、男性乳房发育症、阳痿及勃起功能障碍。其中18例患者接受溴隐亭治疗，5例接受卡麦角林治疗。经平均7.83±6.97个月的治疗周期（治疗时长范围1~29个月）后，所有患者的催乳素水平均恢复正常，垂体高度显著降至4.39±1.37 mm，多数患者报告临床症状得到显著改善，尤以性功能改善最为明显。 研究结论：伴性腺功能减退症的特发性高催乳素血症偶可表现为睾酮水平正常，这提示临床需超越常规激素评估范畴，提高警惕性。垂体高度降低可作为重要的诊断标志物及治疗有效性评估指标。包括溴隐亭或卡麦角林在内的药物治疗可有效使激素水平恢复正常并显著改善临床症状，临床实践中可根据具体情况优先选择卡麦角林。