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 Table of Contents  
CASE REPORTS
Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 99-100

Peyroni’s disease maybe initial presentation of diabetes mellitus


Department of Medicine, S. N. Medical College, Agra, Uttar Pradesh, India

Date of Submission12-May-2020
Date of Decision24-May-2020
Date of Acceptance20-Jun-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Dr. Prabhat Agrawal
Department of Medicine, S. N. Medical College, Agra, Uttar Pradesh 282002.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jod.jod_34_20

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  Abstract 

We report a case of a 30-year-old man presenting with complaint of pain during coitus. On history taking and examination, Peyronie’s disease was diagnosed in which the connective tissue of the corpus cavernosum is affected. It is characterized by excessive fibrosis and formation of plaque, causing deformities in the erect state such as curvature, indentation, shortening, and narrowing with a hinge effect, also penile pain with erection. On the basis of deranged blood sugar, he was diagnosed as a case of type 2 diabetes mellitus. We are reporting this case because after control of hyperglycemia, the symptoms and signs of Peyronie’s disease slightly improved.

Keywords: Diabetes mellitus, hyperglycemia, Peyronie’s disease


How to cite this article:
Agrawal P, Gautam A, Parihar A, Singh B. Peyroni’s disease maybe initial presentation of diabetes mellitus. J Diabetol 2021;12:99-100

How to cite this URL:
Agrawal P, Gautam A, Parihar A, Singh B. Peyroni’s disease maybe initial presentation of diabetes mellitus. J Diabetol [serial online] 2021 [cited 2021 Jan 25];12:99-100. Available from: https://www.journalofdiabetology.org/text.asp?2021/12/1/99/304351




  Introduction Top


Peyronie’s disease (PD) is a superficial fibrosing disorder of the penis, resulting in plaque formation and penile deformity.[1] PD usually has association with erectile dysfunction. Prevalence of PD is from 0.4% to 23%. Etiology of PD is multifactorial. Most common etiology is penile trauma, systemic causes are hypogonadism, diabetes, hypertension, and cardiovascular disease.[2],[3] According to few studies, smoking and alcohol consumption are important causes of PD. Francois Gigot de la Peyronie, the French physician and surgeon to King Louis XV, is credited with the initial description of the disease. Diabetes has varied presentations. Here we are reporting a case of young man who presented to us with PD and was found to be diabetic, which improved with control of hyperglycemia.[4]


  Case Report Top


A 30-year-old Indian man presented to outpatient department with complaint of pain in the penis during the act of coitus and also of slight bending of penis. He is barber by occupation and did not consume alcohol and tobacco. No history of trauma to penis or pelvic area was reported. No history of hypertension, diabetes, and tuberculosis was noted. On examination, his vitals and systemic examination were within normal limit, and his body mass index (BMI) was 25.5. On local examination of penis (by goniometer), there was a slight bending of 20°. On further questioning, he also revealed that due to pain during the act of coitus, he developed loss of libido and unexplained weakness and increased sense of thirst.

On laboratory investigation, his complete blood count (CBC), liver function test (LFT), and kidney function test (KFT) were normal. His serology for human immunodeficiency virus (HIV), hepatitis B surface antigen (HbsAg), anti-HCV (hepatitis C virus), and veneral disease research laboratory test (VDRL) was negative. Dermatology opinion was taken to rule out sexually transmitted disease. He also did not have any pain in the lower back or pelvic area. His random blood sugar was 284 mg/dL, which was further confirmed by oral glucose tolerance test (OGTT) (fasting—146 mg/dL, at 2 h—248 mg/dL) and HbA1c—8.4%; serum testosterone level was 610 ng/mL (270–1070 ng/mL). There was no family history of diabetes mellitus (DM). A penile Doppler ultrasonography was done in full erection for evaluation of penile arterial and venous system, which showed few amorphous areas of ill-defined echogenicity within the substance of mid and lower segments of both corpora cavernosa, suggesting early fibrotic/calcified plaque formation along with few foci of calcification along the walls of left corpora cavernosa, which confirmed PD. On the basis of deranged blood sugar, he was diagnosed as a case of type 2 diabetes mellitus (T2DM); he was started on oral hypoglycemic agents (OHA) and his glycemic targets were achieved after 2 weeks. His symptoms of hyperglycemia also improved. Gradually during the period of 1 month, his complaint regarding pain during coitus and subjective feeling of slight bending of penis (10°) also improved. We are reporting this case because after control of blood sugar, symptoms and signs of PD improved.


  Discussion Top


DM is a chronic metabolic disorder, sharing a phenotype of hyperglycemia, resulting from contributing factors. The metabolic dysregulation in the liver leads to pathophysiological changes in multiple organ systems, giving rise to various complications and imposing a tremendous burden on diabetic individual and health-care system. DM is the disease known to mankind from ancient times. It has become one of the major challenges to public health in the twenty-first century. As per estimation, approximately 300 million patients may get affected by 2025.[5],[6]

DM can present vividly. For the diagnosis of PD, we relied on history and physical and radiological (Doppler) examination of the penis. Penile ultrasonography was used as a tool to confirm penile plaque diagnosis.

PD has been reported in literature in patients who were diagnosed late for T2DM, that is, patients with PD and DM also present in the later stages of the disease. PD occurred in 8% of patients with diabetes and in 20% of patients who have both diabetes and PD. The risk of acquiring PD increases with advancing age. A significant association between PD and both long duration and metabolic control of diabetes was confirmed.[7] A nodule on the shaft of the penis can be palpated during the acute phase of the disease, which lasts for about 12–18 months.


  Conclusion Top


There is a need for early screening of PD in younger patients presenting with various complaints. Screening program in hospital urological departments and outpatient clinics for patients with T2DM could provide the early treatment and prophylactic measures.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kadioglu A, Tefekli A, Erol B, Oktar T, Tunc M, Tellaloglu S A retrospective review of 307 men with Peyronie’s disease. J Urol 2002;168:1075-9.  Back to cited text no. 1
    
2.
Levine L, Rybak J, Corder C, Farrel MR Peyronie’s disease plaque calcification—Prevalence, time to identification, and development of a new grading classification. J Sex Med 2013;10:3121-8.  Back to cited text no. 2
    
3.
El-Sakka AI, Tayeb KA Peyronie’s disease in diabetic patients being screened for erectile dysfunction. J Urol 2005;174:1026-30.  Back to cited text no. 3
    
4.
Habous M, Malkawi I, Han E, Farag M, Muir G, Abdelwahab O, et al. Peyronie’s disease is common in poorly controlled diabetics but is not associated with the metabolic syndrome. Urol Ann 2019;11:252-6.  Back to cited text no. 4
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5.
Arafa M, Eid H, El-Badry A, Ezz-Eldine K, Shamloul R The prevalence of Peyronie’s disease in diabetic patients with erectile dysfunction. Int J Impot Res 2007;19:213-7.  Back to cited text no. 5
    
6.
Chahar RS, Agarwal P, Parihar A, Sharma RA, Boentika Singh NP Study on the prevalence of various complications among the diabetic population around the central region of India. J Intern Med India [Internet] 2019;13:44-50.  Back to cited text no. 6
    
7.
Ralph D, Gonzalez-Cadavid N, Mirone V, Perovic S, Sohn M, Usta M, et al. The management of Peyronie’s disease: Evidence-based 2010 guidelines. J Sex Med 2010;7:2359-74.  Back to cited text no. 7
    




 

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