Diagnosis and management of "endocrine impotence".

Abstract

Aetiologically speaking impotence may be predominantly "constitutional," "psychogenic," or "organic."To summarize the main characteristics, "constitutional" impotence is usually associated with persisting evidence of low sexual drive and responsiveness; some extreme cases, because of profound sexual indifference, will neither have engaged in self masturbation nor have sought out heterosexual or homosexual contacts during their entire lives.There is no demonstrable organic pathology in these cases.Unless constitutional factors are dominant or the condition is congenital, "organic impotence" will have developed from previous competence in association with some pathological lesion.Clinically, "organic" impotence is stated to be constant and persists unchanged irrespective of the nature of any sexual stimulation which might be provided.By contrast "psychogenic" impotence is alleged to be selective and transient, occurring in certain situations and at certain times.These, then, are the theoretical differences between the three postulated aetiological types of impotence.Nevertheless, in practice the distinction is not always easy or even possible.Simpson' reminds us that aetiological overlap may occur; thus, though impotence may be predominantly "constitutional," "organic," or "psychogenic," in some cases the three factors may co-exist and complicate each other to a greater or lesser degree.The clinician's task is to institute the relevant investigations and to determine any aetiology in the individual case, so that he can institute rational treatment.Organic Impotence "Organic impotence," which is usually considered to account for only about 5% of all cases, may occur with any debilitating disease, metabolic disorders, disorders of the central nervous system, cardiovascular diseases, after the use of some drugs, and diseases of the endocrine system.This article is concerned with the diagnosis and management of "endocrine disease impotence."The following disorders may be associated with difficulty or failure to achieve erection: acromegaly, Addison's disease, adrenal neoplasms (with or without Cushing's syndrome), castration, chromophobe ade- noma, craniopharyngioma, diabetes mellitus, eunuchoidism (including Klinefelter's syndrome), feminizing interstitial- cell tumour, infantilism, ingestion of female hormones and antiandrogen substances (both iatrogenic), myxoedema, obesity, and thyrotoxicosis.This diverse list of endocrine causes of impotence has been taken from the published work.*It is, in *In some cases the cause can be only presumed, since only a few clinical reports are available in the literature.