Prolactinoma: A rare, important and treatable cause of male infertility

Abstract

Infertility as a result of hyperprolactinemia from a functional prolactinoma is a rare yet treatable cause of morbidity. As in this case, if infertility is the presenting symptom, then urology is only the first specialty needed along the road of effective treatment, highlighting the role of the multidisciplinary team. What made this case so interesting was the almost immediate return to fertility on tumour resection (as shown by the resulting pregnancy) and the emphasis the patient placed on his fertility, above all other concerns. It shows that in complex cases such as these, medical and surgical specialities have to work together to achieve the outcome that is in the best interests of the patient. We present the case of a 33-year-old man who presented with anejaculation and a loss of fertility that lead to significant patient distress. After surgery and hormone replacement, the patient showed an increase in sperm count, normal morphology and density. This report will highlight the journey that the patient underwent from diagnosis through investigations and surgery in order to re-establish fertility. The aim of this case report is to highlight the need to consider hyperprolactinemia as a cause of reversible male infertility and to show the potentially short-term positive impact of effective treatment. The report provides fertility data to quantify this improvement after both endocrinology and then neurosurgical intervention. This case is a wonderful example of the success a multidisciplinary approach can have in the treatment of a complex, rare condition. Level of evidence: Case report – level 5