Recovery of Male Sexual Function and Serum Testosterone After Endoscopic Transnasal Transsphenoidal Resection of Pituitary Adenoma: A Prospective Cohort Study

Abstract

Background: Sexual dysfunction is a frequent but under-assessed manifestation of pituitary adenoma in men; this is most often secondary to pituitary-gonadal axis suppression. It is uncertain whether ETTSs reverse such a deficiency; prospective studies using a validated symptom scale together with objective measurement of serum concentrations are uncommon. Herein we assess erectile function and serum testosterone concentration before and after ETTS in men with an ED presentation of pituitary adenoma.
Methods: We conducted this single-center, prospectively collected cohort of 17 consecutive men with pituitary adenoma and ED to have an ETTS. The 5-item IIEF-5 and total testosterone levels were recorded preoperatively and postoperatively and assessed. records of visual fields, extent of surgery, and complications were taken. Paired changes were evaluated with the Wilcoxon signed-rank test, and proportions are reported with a 95% Wilson CI.
Result. The mean age of patients was 44.6 ± 9.8 years. At baseline, patients showed ED, subnormal testosterone, and raised prolactin (15 patients, 88.2%). The mean IIEF-5 increased in all patients by 5.2 [95% CI 4.1-6.3] with an improvement in each case, from a preoperative mean IIEF-5 score of 12.7 ± 3.4 to a postoperative IIEF-5 score of 17.9 ± 3.0 (p < 0.001; r = 0.88). Overall, testosterone increased from 1.23 ± 0.50 to 2.90 ± 0.57, with 16 patients showing an increase (94.1%); 95% CI 1.23-2.13. Gross total resection was achieved in 16 of the 17 men (94.1%), with complete loss of testosterone only occurring in the one patient not receiving GTR. The change in IIEF-5 did not correlate significantly with the change in testosterone levels (Spearman 0.21, p 0.42). Two complications (11.8%) occurred: 1 CSF leak with associated sinusitis and 1 case of epistaxis, without significant morbidity. No patients suffered injury of vessels or de novo hypopituitarism.
Conclusions: ETTS was associated with reliable regain of sexual function and remarkable rise in serum testosterone with low morbidity. As hormonal regain was unrelated to functional regain, sexual function appears multifactorial. Our conclusion strongly warrants serial evaluation of sexual function preoperatively and postoperatively for any elective pituitary adenoma operation.