Pituitary Disease - Causes of Male infertility

A. Pituitary Insufficiency
Pituitary insufficiency may result from tumors, infarcts, surgery, radiation, or infiltrative and granulomatous processes. In sickle cell anemia, pituitary and testicular microinfarcts from sickling of red blood cells are suspected of causing infertility. Men with sickle cell anemia have decreased testosterone and variable LH and FSH levels. β-Thalassemia patients have mutations in the β-globin gene that lead to an imbalance in α and β globin composition of hemoglobin; these patients are mainly of Mediterranean or African origin. Infertility is also believed to result from the deposition of iron in the pituitary gland and testes. Similarly, hemochromatosis results in iron deposition within the liver, testis, and pituitary and is associated with testicular dysfunction in 80% of cases.

B. Hyperprolactinemia
Another form of hypogonadotropic hypogonadism is due to elevated circulating prolactin. If hyperprolactinemia occurs, secondary causes such as stress during the blood draw, systemic diseases, and medications should be ruled out. With these causes excluded, the most common and important cause of hyperprolactinemia is a prolactin-secreting pituitary adenoma. High-resolution CT scanning or MRI of the sella turcica has classically been used to distinguish between microadenoma (< 10 mm) and macroadenoma (> 10 mm) forms of tumor. Stratification of disease based on radiologic diagnosis alone is misleading, as surgery for hyperprolactinemia almost always reveals a pituitary tumor. Elevated prolactin usually results in decreased FSH, LH, and testosterone levels and causes infertility. Associated symptoms include loss of libido, impotence, galactorrhea, and gynecomastia. Signs and symptoms of other pituitary hormone derangements (adrenocorticotropic hormone, thyroid-stimulating hormone) should also be investigated.

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