Endocrine Abstracts

Aim

The aim of this study was to evaluate: a) the prevalence of a previously unknown endocrine / metabolic dysfunction, namely hypogonadism, thyroid dysfunction, hyperprolactinemia, and diabetes or prediabetes, in a population of patients affected by Erectile Dysfunction (ED); b) the differences in ED severity according to the presence/absence of specific endocrine / metabolic dysfunctions.

Material and Methods

A total of 1332 subjects, referred to the Andrology Unit (Sant’Andrea University Hospital of Rome) for a condition of ED, were studied. Exclusion criteria were: i) age <18 or >75 years; ii) already diagnosed of endocrine/metabolic disorders, as listed above. The study included: andrological clinical examinations and hormonal profile. The diagnosis of ED was made using the International Erectile Function Index-5 questionnaire (ED: total score ≤21). ED severity was considered according to presence/absence of spontaneous erections, maintenance/achievement deficiency.

Results

Overall, the mean ± SD age was 54.3±13.7 years. A rate of 88.3% of the patients had a stable relationship; 80.0% of the patients referred difficulty in the maintenance of the erection, while 19.9% in the achievement. The spontaneous erections were absent in 24.0% of patients, sporadic in 50.7% and present in the remaining 25.2%. In the 10.3% of the patients there was at least another one sexual or ejaculatory dysfunction (premature/delayed/retrograde ejaculation, anorgasmia, low sexual desire). A total of 19.4% of the patients were already in treatment for glycaemic disorders or endocrine dysfunctions. Among the remaining 1077 patients, the prevalence of subjects with unknown endocrine/metabolic disorders was 30%. Particularly, 190/1077 (17.6%) were diagnosed as affected by hypogonadism (total testosterone < 2.64 mg/dl) 56/1077 (5.2%) diabetes (DM; HbA1c: ≥ 6.5%) or prediabetes (HbA1c 6–6.5%), 40/1077 (3.7%) thyroid dysfunction (TSH<0.3 ulU/ml or TSH>10 ulU/ml), 37/1077 (3.4%) hyperprolactinemia (PRL >25 ng/ml). Among the subgroups, patients with hyperprolactinemia were younger compared to the total group (44.6±12.9 years; P < 0.05), and patients with new diagnosis of DM showed more severe form of ED compared to the total group (difficulty in the achievement of erection: 46/56 (82.2%, P < 0.05; absence of spontaneous erection 23/56 (41.1%), P < 0.05).

Conclusions

In this study, a new diagnosis of an endocrine and/or metabolic dysfunction was carried out in more than a quarter of cases. Since most endocrinologic causes of ED are treatable, every effort should be made to exclude potential hormonal aetiologies underlying ED at an early stage. Finally, ED should also be considered as an early marker of DM as well as endocrine dysfunctions.