Abstract. Twenty-three patients (13 females, 10 males) with panmyelopathy (N = 9), chronic leukemia (N = 5), and acute leukemias (N = 9) were studied 1 to 6 years following allogenic bone marrow transplantation. All patients had received conditioning treatment with cyclophosphamide prior to aBMT, and 2 of the patients with bone marrow aplasia and all of the leukemia patients had been given radiotherapy. An endocrine assessment was performed by means of TRH, GnRH, oCRF and GHRH tests and estimation of thyroid and gonadal hormones. Whereas pituitary-adrenal function appeared to remain stable, there was a 17.4% incidence of subclinical hypothyroidism (25% of the irradiated patients). Growth hormone reserve was diminished, and ovarian failure occurred in all female patients after radiotherapy, whereas in the men, only a moderate elevation of gonadotropins was observed. Our results warrant observation of thyroid and gonadal function, and in children of growth hormone secretion, after allogenic bone marrow transplantation. They also show that replacement therapy may be needed in some patients.
Elevated levels of prolactin (PRL) are associated with gonadal dysfunction in men and women, but the relationship between PRL levels and gonadal activity is best defined in women. The purpose of this review is to summarize and discuss the influence of PRL on the male reproductive function in normaprolactinemia and to describe the clinical, diagnostic, and therapeutic aspects of the male hyperprolactinemia syndrome as related to sexual dysfunction and infertility.
A protocol for the assessment of oligozoospermia prior to AIH is presented. Three to six carefully performed semen analyses at optimal intervals are required to confirm oligozoospermia. Routine semen analysis consist of volume, pH, viscosity, sperm count, motility, morphology, agglutination, fructose content, and leukocytes. Because of the high incidence of reproductive tract infection and chromosomal abnormalities in oligozoospermic men, microbiological investigation and full chromosomal analyses should be performed in all cases with sperm counts below 10 million/ml. Chromosomal abnormalities are an indication to reject a couple from AIH. Genital tract infections must be treated prior to insemination. Only sperm counts below 10 million/ml require the estimation of FSH levels. The existence of an oligozoospermia group with pituitary adenoma justifies routine PRL measurements in all cases of oligozoospermia and further investigations such as visual field examination and sella tomogram in case of hyperprolactinemia. Testicular biopsy may indicate an epididymal block that can be surgically repaired. Simultaneous in-depth evaluation of the female partner is emphasized, as oligozoospermia in the man does not rule out the possibility of an additional infertility factor in his partner. It is still controversial whether or not AIH, as compared to intercourse, will improve the conception rate for oligozoospermic men.
Zusammenfassung Die Anamnese im klassischen Arzt-Patientengespr?ch ist heutzutage nicht mehr der einzige Kommunikationsweg zwischen Betroffenem und Behandelndem. H?ufig werden zur ersten Kontaktaufnahme bei der Besch?ftigung mit einem spezifischen Gesundheitsproblem oder im Sinne der Einholung einer Zweit- oder Drittmeinung auch neue Medien herangezogen. Hierzu geh?rt auch der Besuch von Internet-Blogs und -Foren, die eine anonyme Frage erm?glichen. Ein solches Angebot stellt der Webauftritt ?dieBlase.de? der Dr. R. Pfleger Arzneimittel in Bamberg dar, dessen Anfragen aus 20 Monaten ausgewertet wurden. Es dominierten weibliche Betroffene, Fragen von bzw. zu Kindern/Jugendlichen bzw. von M?nnern wurden nur ausnahmsweise gestellt. Die Fragen kreisten im Wesentlichen um 3 Themengruppen: Nebenwirkungen zu einer bereits begonnenen Therapie, Suche nach L?sungen komplexer Kontinenzprobleme bzw. bisher frustraner Therapie und die Wertigkeit von Selbsthilfema?nahmen wie Beckenbodengymnastik, Verhaltensinterventionen oder Fl?ssigkeitsmanagement. Die Komplexit?t der aus den Fragen durchscheinenden Kontinenzprobleme und die Suche nach kompetenten Ansprechpartnern lassen das Angebot einer internetbasierten ?Sprechstunde? neben den klassischen Behandlungsangeboten der ?rztlichen Praxis gerade bei einem Tabuthema als besonders sinnvoll erscheinen.
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