Androlog Mail
I have a perplexing case about which you andrological endocrinology experts
might have some thoughts.
The patient is a 37 year old healthy man who had a right orchiopexy at age 18
for torsion. It is not clear whether the left side was pexed at that time or
not. I first saw him in 1999 when he and his then 33 year old wife were
trying to get pregnant for the first time. He had a small left varicocele.
His left testis had a volume of about 15 ml. and normal consistency. His
right testis had a volume of about 10-12 ml. and soft consistency. His sperm
concentration was 40M/ml, his motility was 60% and Kruger morphology showed
15% normal forms. I recommended against a varicocele repair. His wife got
pregnant in Jan 2000 and they had a healthy boy in October 2000.
Trying for a second pregnancy, he had another S/A in early July 2002. It was
azoospermic with normal pH and volume. I saw him on 7/29/02. His left testis
was the same size as in 1999 but the consistency was perhaps slighty softer.
I was not convinced that I could palpate the varicocele which I had palpated
in 1999. His right testis was replaced by a hard mass. I did a right radical
orchiectomy on 7/30/02. Pathology was pure typical seminoma. Pre and postop
serum beta-HCG and AFP have been zero. He had 2450 rads of adjuvant XRT to
his retroperitoneum in September 2002. His S/A have continued to be
azoospermic with normal volume and pH to the present time.
Here's the curiosity. He has hyperprolactinemia and possibly
hypotestosteronemia. He is not taking any meds. The following are his
endocrine values on several occasions:
Date PRL FSH LH T
7/30/02 7.5 88
8/8/02 64.2 7.3 3.8 179
8/16/02 74.5 7.7 2.7 277
8/26/02 303
10/29/02 69.1
11/06/02 8.9 2.5 197
2/28/03 70.5 8.8 4.6 216
(Normals 1.6-18.8 1-8 2-13 280-800)
(In case the rows and columns do not reproduce understandably, I am listing
the lab results as line items by date as well.
On 7/30/02: FSH was 7.5 and T was 88
On 8/8/02: PRL was 64.2, FSH was 7.3, LH was 3.8 and T was 179
On 8/16/02: PRL was 74.5, FSH was 7.7, LH was 2.7 and T was 277
On 8/26/02: T was 303
On 10/29/02: PRL was 69.1
On 11/06/02: FSH was 8.9, LH was 2.5 and T was 197
On 2/28/03: PRL was 70.5, FSH was 8.8, LH was 4.6 and T was 216
Normal values are: PRL 1.6-18.8, FSH 1-8, LH 2-13 and T 280-800.)
A cranial MRI in November 2002 was normal.
Among many questions are:
Is this patient's azoospermia related to his seminoma? If so, how?
Is there a relationship between his testis ca and hyperprolactinemia?
Are the T values related to the hyperprolactinemia?
Would treatment of hyperprolactinemia affect his azoospermia?
Any thoughts or suggestions would be very much appreciated by me and the
patient.
Ira Sharlip
ISharlip@aol.com
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