Abstract: the aim of this study is to improve the results of diagnosis and treatment of patients with erectile dysfunction (ED), combined with the syndrome of “empty Turkish saddle” (ETS).
Material and methods. The results of examination and treatment of 118 patients with dishormonal ED at the age of 23-57 years were studied. The severity of violations of erectile function and signs of androgen deficiency, as assessed by the questionnaire and the AMS Morley scale, the penile echocardiography with intracavernosal pharmacological was conducted, hormonal status was evaluated. If in any doubt on the neuroendocrine pathology performed MRI of the brain. Patients did not previously suffer from the syndrome of “empty Turkish saddle” (ETS), the diagnosis was made accidentally when they were treated for erectile dysfunction. None of the surveyed did not previously receive systemic therapy drugs, potentially causing hypopituitarism, in particular anabolic steroids. Fertility assessment was not carried out, as the subject of treatment of patients was the lack of erectile function, most of the examined were married, did not suffer from infertility and had children.
Results. All examined patients showed signs of erectile dysfunction. 62 (52,5%) patients of the 118 during MRI revealed syndrome of “empty Turkish saddle” (ETS). In 22 (18.6%) cases there were changes in the fundus, indicating an increase in intracranial pressure, but the loss of visual fields was not observed in any patient. Persistent headaches were noted in 19 (16.1%) cases. In 46 (39%) cases in patients with significant obesity, signs of impaired glucose tolerance and insulin resistance were revealed. In the complex therapy of ED in patients with identified hormonal disorders, replacement therapy (HCG in combination with testosterone) was prescribed, in the detection of hyperprolactinemia, dopamine receptor agonists were used in an individual dosage under the control of prolactin level. Treatment of intracranial hypertension was mandatory in all patients – osmotic diuretics were used. In all cases, the therapy was effective, during the treatment there was an increase in the frequency and duration of sexual acts. Control Doppler studies of the penis showed improvement in regional hemodynamics. Cancellation of drugs led to the resumption of symptoms of the disease.
Conclusion. The study demonstrates the significant importance of the syndrome of “empty Turkish saddle” (ETS) in the pathogenesis of ED. It is important to note that ETS, in most cases, is a random tomographic finding, while often accompanied by a violation of glucose tolerance, obesity, metabolic syndrome. Syndrome ETS is necessary to be clearly diagnosed and, if necessary, to assign etiotropic and pathogenetic. For proper diagnosis, treatment and monitoring of ETS syndrome requires a multidisciplinary approach with the involvement of related professionals – endocrinologists, neurologists and ophthalmologists.
Keywords: erectile dysfunction, “empty Turkish saddle” syndrome, morbid obesity, hormone replacement therapy