Erectile Dysfunction – An Under-Recognised Presentation of Acromegaly
M Lepore, S Zaman, B Patel, R Kaushal
We present a 40 year old male who was referred by his GP with erectile dysfunction (ED). He and his wife had been trying to conceive for 5 years. He had a past medical history of obstructive sleep apnoea and was under the respiratory and ENT teams. He did not tolerate home CPAP and had a tonsillectomy in 2013. There was no history of diabetes or hypertension. During the initial consultation, he reported that his features had changed significantly over the past 10 years, specifically mentioning increasing shoe size. He denied headaches and sweating.
On examination he weighed 94kg and was normotensive. He had prominent nasolabial folds, macroglossia, prognathism and doughy hands. Cardiac auscultation was unremarkable. Visual fields were full to confrontation. There was no thyroid nodularity.
His investigations revealed IGF-1 133.9 (13-50 nmol/L), FSH 6.6 (1.3-19.3 IU/L) and LH 6.0 L (1.2 – 8.6 IU/L). Testosterone 4.1 (6.1 – 27.1 nmol/L). Prolactin 152 (56-278 mIU/L). Free T4 9.2 (8.4 – 19.1 pmol/L). Cortisol 390 (185 – 624 nmol/L).
MRI showed a 1.5 cm mass in the left side of the pituitary consistent with a macroadenoma. The mass extended inferiorly into the adjacent sphenoid sinus with no compression of the optic chiasm.
He was then referred to a tertiary centre for surgery.
It is not widely appreciated that ED is a recognised feature of acromegaly; up to 42% of patients with acromegaly report ED.1 It is extremely important that patients presenting with ED are thoroughly assessed to exclude organic and potentially reversible causes of their symptoms.