Early Prolactin Screening in Evaluation of Erectile Dysfunction

Prolactinomas are often diagnosed later in men due to non-specific symptoms such as erectile dysfunction (ED) and fatigue rather than classic endocrine symptoms. Delayed recognition can have significant impact on the patient, and making a timely diagnosis is essential. This case describes a 75-year-old male who presented with fatigue and erectile dysfunction, prompting an evaluation that led to the diagnosis of hyperprolactinemia and subsequently a finding of a pituitary macroadenoma. Imaging revealed a Knosp grade 4 prolactinoma, and laboratory studies confirmed secondary hypogonadism. The patient was started on dopamine agonist therapy, which normalized his prolactin levels, improved testosterone levels, and improved his symptoms, including ED and fatigue. This case demonstrates the importance of considering endocrine causes of hypogonadism in the evaluation of ED. Prolactin-induced hypogonadism is a reversible and treatable condition, and early identification can prevent tumor progression and reduce long-term morbidity. Medical therapy with dopamine agonists remains the first-line treatment and can lead to significant improvement in hormonal function and quality of life. Incorporating prolactin screening into the initial evaluation of ED may lead to earlier diagnoses and improved outcomes in older male patients.