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Ïðîëàêòèí áåñïëîäèå ìóæ÷èíà Ïëàíèðîâàíèå äåòåé
Ìóæ÷èíà, 44 ãîäà. Âïåðâûå íà ïðè¸ìå ó ýíäîêðèíîëîãà.
Æàëîáû (äèíàìèêà) : íà ñíèæåíèå ñåêñóàëüíîé àêòèâíîñòè, ëèáèäî â òå÷åíèè 5-6 ëåò, áåñïëîäèå (ïåðâè÷íîå). Ïðè÷èíà îáðàùåíèÿ - ïëàíèðîâàíèå äåòåé. Ðåçóëüòàòû ëàáîðàòîðíî-èíñòðóìåíòàëüíûõ ìåòîäîâ îáñëåäîâàíèÿ: Îò 16.02.2024ã. ÎÀÊ: Le 4,5 (3,91-8,77), Er 5,27 (4-5,6) Hgb 155 ã/ë (128-172), Hct 46,1 % ( 38-49) Íåéòðîôèëû 38,2% (40,3-74,8), Ýîçèíîôèëû 9,8% (0-4,4), ÑÎÝ 2 (2-15). Îò 23.04.2024ã. : ÒÒà 1,93 ìÅä/ë (0,35-4,95), ñâ.Ò4 11,1 ïìîëü/ë (9,01-19,05); Êîðòèçîë 329,4 íìîëü/ë (óòðîì 101,2-535,7) Èíñóëèí 11,5 ìêÅä/ìë (2,1-29,1) Ãëþêîçà êðîâü 5,67 ììîëü/ë (3,9-6,1), Èíäåêñ ÍÎÌÀ 2,9 (0-2,7); Òåñòîñòåðîí 16,55 íìîëü/ë (8,33-30,19), ñâîáîäíûé òåñòîñòåðîí 132,1 ìã/ìë (46-224), Àëüáóìèí 41,1 ã/ë (35-52), ÃÑÏà 20,10 íìîëü/ë (13-71). Îò 27.04.2024ã. Invitro: Ïðîëàêòèí 2907 ìÅä/ë (73-407) Ïðîëàêòèí ìîíîìåðíûé (ïîñò-ÏÝÃ) 128 ìÅä/ë (72-229) Õîëåñòåðèí 5,68 ììîëü/ë (ìåíåå 5) ÏÑÀ îáùèé 0,673 íã/ìë (ìåíåå 4,4) ÏÑÀ ñâîáîäíûé 0,334 íã/ìë ÏÑÀ ñâîáîäíûé/ÏÑÀ 49,6% Îò 04.05.2024ã. Citilab: Ïðîëàêòèí 35,4 íã/ìë (4-15,2) Ëà 2,98 ìÌÅ/ìë (1,78-8,6) ÔÑà 2,51 ìÌÅ/ìë (1,5-12,4) Îò 07.05.2024ã. ÌÐÒ ãîëîâíîãî ìîçãà ñ ÊÓ ( ãèïîôèç): îðãàíè÷åñêîé ïàòîëîãèè ãîëîâíîãî ìîçãà è ãèïîôèçà íå âûÿâëåíî. Îò 07.05.2024ã. ÒÐÓÇÈ ïðåäñòàòåëüíîé æåëåçû è ÓÇÈ ìîøîíêè Çàêëþ÷åíèå: ýõîïðèçíàêè êèñòû ãîëîâêè ïðèäàòêà ëåâîãî ÿè÷êà, êàëüöèíàòà â ìåæîáîëî÷å÷íîì ïðîñòðàíñòâå ñëåâà. ÓÇÈ ïî÷åê è çàáðþøèííîãî ïðîñòðàíñòâà. Ñâîáîäíîé æèäêîñòè íå îïðåäåëÿåòñÿ. Çàêëþ÷åíèå: ñîíîãðàôè÷åñêàÿ êàðòèíà äèôôóçíûõ èçìåíåíèé ïàðåíõèìû è ñèíóñà îáåèõ ïî÷åê, êîíêðåìåíòû ñ îáåèõ ñòîðîí (äî 17ìì). Êîëëåãè, ïîäñêàæèòå, ïîæàëóéñòà Äèàãíîç è äàëüíåéøóþ òàêòèêó âåäåíèÿ äàííîãî ïàöèåíòà. Ñ óâàæåíèåì, Àííà. |
#2
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ðîñò è âåñ ìóæ÷èíû? áåñïëîäèå ïåðâè÷íîå - â òå÷åíèå êàêîãî âðåìåíè? ó íåãî åñòü ðåãóëÿðíàÿ ïîëîâàÿ æèçíü áåç ïðåäîõðàíåíèÿ ñ òåì ÷åëîâåêîì, ñ êåì ïëàíèðóþò äåòåé? ðåç-ò ñïåðìîãðàììû?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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ðîñò 182 âåñ 109êã ÈÌÒ 33êã/ì2. Ñïîðò 3 ðàçà â íåäåëþ (êàðäèîíàãðóçêè), ïîñòîÿííî íà ãèïîêàëîðèéíîé äèåòå, çà 2 ãîäà âåñ óìåíüøèëñÿ íà 15êã. Ïåðåä ñäà÷åé Ïðîëàêòèíà ôèçè÷åñêèå íàãðóçêè îòìåíåíû. Ðåãóëÿðíîé ïîëîâîé æèçíè íåò èç-çà ñíèæåíèÿ ëèáèäî è íàðóøåíèÿ ýðåêòèëüíîé ôóíêöèé îêîëî 5-6 ëåò (ïîëîâîé àêò 1 ðàç 2-3 ìåñÿöà). Ïîñòîÿííàÿ ïàðòí¸ðøà - æåíà â òå÷åíèè 17 ëåò. Áåðåìåííîñòåé íèêîãäà íå áûëî. Áûëè ó àíäðîëîãà, ñî ñëîâ - ñïåðìîãðàììà íîðìàëüíàÿ.
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#4
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âîò ïðèìåð êëèíè÷åñêîãî ñöåíàðèÿ, êîòîðûé áûòü ìîæåò ïîäõîäèò ïîä Âàø ñëó÷àé è ÷òî Âû íåäîñêàçàëè â îïèñàíèè èñòîðèè ïàöèåíòà ïîä÷åðêíóòî ìíîé:
A 32-year-old man presents complaining of infertility of >12 months duration and confirms he is having regular intercourse with this wife. He denies any past medical or surgical history of relevance. He is not taking any prescribed or over the counter medications. Clinical examination was unremarkable. Laboratory investigation revealed that he had oligospermia. His hormone evaluation revealed an FSH level of 2.1 IU/L, LH level of 3.2 IU/L, testosterone level of 13.5 mmol/L, and prolactin level of 34 µg/L.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#5
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÷òî ïðåäëàãàåòñÿ äåëàòü â ïîäîáíîì ñëó÷àå
the mild elevations in prolactin level may be attributed to physiological causes such as stress, exercise or excessive venepuncture. It might also be secondary to concurrent intake of prescription medications such as antipsychotic agents, metoclopramide and cimetidine, but it is also important to ask about additional over the counter supplements and any herbal preparations. In this case the prolactin level measurement should be repeated on three occasions after the assumed cause has been dealt with; if any one of those three measurements is normal then it can be assumed that this is stress induced hyperprolactinaemia or that the cause (such as over the counter medication) has been addressed. Alternatively a 5-point cannulated prolactin profile from 0800 h to 1200 h has also be advocated [23], when the prolactin may then fall to normal, although this necessitates a prolonged outpatient or day case admission.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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Öèòàòà:
Male infertility: an obstacle to sexuality? [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
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Óâàæàåìûé Âàäèì Âàëåðüåâè÷! Ñïàñèáî çà îòâåò.
Ëåêàðñòâ íåò, ñòðåññà íå áûëî. Ñ óâàæåíèåì, Àííà. |
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#8
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Ó íåãî íîðìàëåí ìîíîìåðíûé ïðîëàêòèí- òî åñòü íåò ãèïåðïðîëàêòòíåìèè
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Ã.À. Ìåëüíè÷åíêî |
#9
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îïÿòü æå, ÷òî âèæó ïî ïðîëàêòèíó ó ìóæ÷èí ñ îæèðåíèåì åãî öèôðû áûâàþò äî 30,
89 male obese patients were included in this study. Their average age was 24.5 ± 9.0 years and BMI was 42.8 ± 9.1 kg/m2. The average waist circumference and body fat percentage was 129.6 ± 19.6 cm and 42.9 ± 8.0%, respectively. The median prolactin levels were 10.0 ng/ml (range: 3.93–30.1 ng/ml). ó ïàöèåíòîâ ñ ïðîëàêòèíîìîé ñðåäíèå öèôðû ïðîëàêòèíà â 6-10 ðàç âûøå âåðõíåé ãðàíèöû íîðìû, íî ìèíèìàëüíî áîëåå 50 èëè òðîåêðàòíîå ïîâûøåíèå îò âåðõíåé ãðàíèöû íîðìû: The median PRL levels was 149 ng/ml (49–732 ng/ml) Äà ó íåãî ìàêðîïðîëàêòèíåìèÿ - òàì äî 80% ìàêðîïðîëàêòèíà, òî åñòü ìîíîìåðíûé ïðîîàêòèí íå 30 íã/ ìë, à õîðîøî åñëè 6 íã/ ìî
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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Àíàëèç ñïåðìû âûïîëíÿëñÿ?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#12
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íóæíî óòî÷íèòü ó ïàöèåíòà, êîãäà çà âñå ýòè 17 ëåò ñîâì. æèçíè ïîÿâèëîñü æåëàíèå çà÷èíàòü äåòåé, åñëè ïîñëåäíèé ãîä-äâà, à äî ýòîãî ïðåäîõðàíÿëèñü, òî òåîðåòè÷åñêè ïðè÷èíó áåñïëîäèÿ íóæíî èñêàòü ó îáîèõ, íî ìîæåò âñå êðîåòñÿ â èõ îáîþäíîì "íåæåëàíèè" - âñå æå 4-6 ÏÀ â ãîä ó ïàðû ïîñëå 40 íå ñàìàÿ ïîäõîäÿùàÿ èíòåíñèâíîñòü äëÿ çà÷àòèÿ
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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Ãàëèíà Àôàíàñüåâíà, ñïàñèáî! ×òî æå ìíå ñ íèì (ïàöèåíòîì) äàëüøå äåëàòü?
Ñ óâàæåíèåì, Àííà. |
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Ó ïàöèåíòà íåò ýíäîêðèíîëîãè÷åñêèõ ïðè÷èí äëÿ áåñïëîäèÿ, åñëè Âû åìó õîòèòå ïîìî÷ü áåç ó÷àñòèÿ äðóãèõ âðà÷åé, åñëè ó Âàñ åñòü òàêèå ïîëíîìî÷èÿ, òî ìîæåòå ïîðåêîìåíäîâàòü åìó åæåäíåâíûé ïðèåì ìèíè-äîç (5 ìã) òàäàëàôèëà:
One study found that tadalafil can increase sperm volume, concentration, and motility in men with unexplained infertility and psychogenic erectile deficiency. Another study found that tadalafil can improve the quality of sperm cells and seminal fluid, including motility, percentage of nemasperms, and volume of seminal fluid.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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Ïðè íîðìàëüíûõ ïðîëàêòèíå, òåñòîñòåðîíå è ñïåðìîãðàììå èñ÷åçíóâøåå ëèáèäî è, êàê ðåçóëüòàò, îòñóòñòâèå áåðåìåííîñòè íàìåêàåò íà åãî ïñèõîëîãè÷åñèå ïðîáëåìû, òèïà “æåíà ïîñëå 17 ëåò áðàêà óæå íå âûçûâàåò æåëàíèÿ èìåòü ñåêñ”.
Æåíó íàäî îáñëåäîâàòü íåïðåìåííî, íî ÷óåò ìî¸ ñåðäöå, ÷òî ïðîáëåìà çàëîæåíà â åãî ãîëîâå. Íó, à íàñ÷åò ÿêîáû ýôôåêòîâ òàäàëàôèëà íà êà÷åñòâî ñïåðìû, íå íàäî çàáûâàòü, ÷òî ñïåðìîãðàììà áûëà äîëîæåíà êàê íîðìàëüíàÿ (÷òî óëó÷øàòü áóäåì?) è òî, ÷òî òàäàëàôèë êàê è Âèàãðà ðàññëàáëÿåò ìûøöû ïðîñòàòû, è äàæå èñïîëüçóåòñÿ äëÿ BPH, íî íå óñèëèâàåò ëèáèäî, â ÷åì è åñòü ãëàâíàÿ æàëîáà ýòîãî áîëüíîãî. Åñëè òàäàëàôèë ýòîé ïàðå è ïîìîæåò , òî åñëè åìó äàâàòü ðåêîìåíäóåìóþ äîçó ( 20 -40 ìã â äåíü èëè õîòÿ áû ïàðó ðàç â íåäåëþ) è àêòèâèçèðîâàòü æåíó, òî íàëè÷èå ýðåêöèè ìîæåò çàñòàâèòü åãî âûïîëíÿòü ñâîé ñóïðóæåñêèé äîëã.
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Dr.B |