A 60-year-old man comes to the office due to erectile dysfunction and lack of sexual desire. Medical history is unremarkable. The patient is in a stable relationship with his wife and does not use tobacco, alcohol, or illicit drugs. The patient has coronary artery disease and heart failure with reduced ejection fraction and was prescribed spironolactone therapy several months ago. Other medications include aspirin, lisinopril, furosemide, and metoprolol. Blood pressure is 110/70 mm Hg and pulse is 70/min. Examination shows a left ventricular S3 and trace pitting ankle edema. Breast examination demonstrates bilateral enlargement with mild tenderness. Which of the following is the most likely cause of this patient's current symptoms?

Question

A 60-year-old man comes to the office due to erectile dysfunction and lack of sexual desire.  Medical history is unremarkable.  The patient is in a stable relationship with his wife and does not use tobacco, alcohol, or illicit drugs.   The patient has coronary artery disease and heart failure with reduced ejection fraction and was prescribed spironolactone therapy several months ago.  Other medications include aspirin, lisinopril, furosemide, and metoprolol.  Blood pressure is 110/70 mm Hg and pulse is 70/min.  Examination shows a left ventricular S3 and trace pitting ankle edema.  Breast examination demonstrates bilateral enlargement with mild tenderness.  Which of the following is the most likely cause of this patient's current symptoms?

Quizplus · Accepted Answer

Eductional Objective: Spironolactone is an aldosterone antagonist commonly used to treat heart failure.  It has significant antiandrogenic effects and can cause gynecomastia, decreased libido, and impotence.  Eplerenone is a more selective aldosterone antagonist with fewer adverse effects.

A 60-Year-Old Man Comes to the Office Due to Erectile