ROUTINE PROLACTIN MEASUREMENT IS NOT NECESSARY IN THE INITIAL EVALUATION OF MALE IMPOTENCE

The authors determined the prevalence of hyperprolactinemia in impoten t men in a community setting and assessed the cost of case detection w ith routine estimation of serum prolactin. They recruited 299 consecut ive patients with impotence and determined the hormonal levels (prolac tin, luteinizing hormone, follicle-stimulating hormone, and testostero ne). Pituitary gland imaging was done when the prolactin level was ele vated. Simultaneous prolactin and testosterone levels were available f or 212 patients. Three patients (1.4%) had elevated prolactin levels b ut none had pituitary tumor. Two of these had low testosterone levels. Overall, 51 patients (24.1%) had low testosterone levels. Cost of sel ective prolactin estimation in patients with low testosterone levels r esulted in a net saving of 12,574 per case detected. The authors concl ude that the prevalence of hyperprolactinemia in impotence is low. Rou tine measurement of prolactin levels in impotence is not indicated. Se lective determination in patients with low testosterone reduces the co st of diagnostic evaluation.