目的:分析鞍区占位病变继发男性性腺功能减退症的临床特点,探索其病因,提高其诊治水平。方法:通过回顾22例鞍区占位病变继发男性性腺功能减退症患者的临床资料,结合文献,分析该病的临床表现、发生原因和治疗原则。22例患者术前出现性腺功能减退症者为A组,术后及放疗后出现者为B组。按内分泌治疗药物分为Andriol组和h CG组。结果:A组患者鞍区占位平均径线[(2.35±0.71)cm]显著大于B组[(1.83±0.36)cm](P<0.05),泌乳素腺瘤的发生率A组也显著高于B组(60%vs 0,P<0.01)。B组患者接受手术及放疗后,黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)水平均明显下降(P均<0.01)。使用十一酸睾酮胶丸和h CG治疗后,Andriol组和h CG组患者T、国际勃起功能指数-5(IIEF-5)评分均较术前明显提高[T,Andriol组:(9.40±2.43)nmol/L vs(2.71±1.39)nmol/L,h CG组:(10.65±2.32)nmol/L vs(3.23±1.53)nmol/L;IIEF-5,Andriol组:(14.50±3.62)分vs(5.00±2.61)分,h CG组:(15.07±3.27)分vs(5.36±1.82)分](P均<0.01);其中以发育迟缓就诊的患者治疗后出现睾丸增大、阴毛生长等青春期发育征象。h CG组睾丸体积明显增大(P<0.01),并有7例产生精子,产生精子者其睾丸初始体积[(11.5±2.3)ml]明显大于未产生精子者[(7.5±2.3)ml](P<0.01)。Andriol组治疗前后睾丸体积无统计学差异,无产生精子的患者。结论:手术和放疗对垂体组织的损伤、病变的占位性效应和高泌乳素血症是鞍区占位性病变引起性腺功能减退的可能原因。十一酸睾酮和h CG均可明显提高T水平和改善勃起功能障碍的症状。十一酸睾酮胶丸治疗对精子生成无治疗效应。 OBJECTIVE: To analyze the clinical features of male hypogonadism secondary to occupying lesions in the saddle area, explore its etiology and improve its diagnosis and treatment. Methods: The clinical data of 22 patients with hypogonadism secondary to occupying lesions in the saddle area were retrospectively analyzed, and the clinical manifestations, causes and treatment principles of the disease were analyzed. Twenty-two patients had hypogonadism preoperatively as A group, and B and B after operation and radiotherapy. Endocrine treatment drugs were divided into Andriol group and h CG group. Results: The mean diameter of saddle area in group A was significantly higher than that in group B (1.83 ± 0.36) cm (P <0.05). The incidence of prolactinomas was also significantly higher in group A In group B (60% vs 0, P <0.01). After operation and radiotherapy, the levels of LH, FSH and T in group B were significantly decreased (all P <0.01). In the Andriol group and the h CG group, the scores of International Erectile Function Index-5 (IIEF-5) were significantly increased compared with the preoperative levels after administration of testosterone undecanoate and h CG [T, Andriol group: (9.40 ± 2.43) (2.71 ± 1.39) nmol / L, h CG group: (10.65 ± 2.32) nmol / L vs (3.23 ± 1.53) nmol / L; IIEF-5 and Andriol group: (14.50 ± 3.62) vs 5.00 ± 2.61, h CG group: (15.07 ± 3.27) vs (5.36 ± 1.82) points respectively (all P <0.01). After treatment, patients with developmental retardation developed adolescent development such as enlarged testes and pubic hair growth Signs. The testis volume in h CG group increased significantly (P <0.01), and sperm produced in 7 patients. The initial volume of testis was significantly higher than that in non-sperm [(7.5 ± 2.3) ml] [(11.5 ± 2.3) (P <0.01). Andriol group testicular volume before and after treatment was not statistically different, no sperm production in patients. Conclusion: The injury of pituitary tissue by surgery and radiotherapy, the occupying effect of lesions and hyperprolactinemia are the possible causes of gonadal dysfunction caused by space-occupying lesions in the saddle area. Eleven acid testosterone and hCG can significantly improve the T level and improve the symptoms of erectile dysfunction. Testosterone undecanoate treatment of sperm produced no therapeutic effect.