Endocrine Abstracts

Introduction: Here, I present an interesting case of stuttering priapism in a 48 years old man. He was 30 years old when he was diagnosed with this condition. He is being treated with cyproterone acetate with significant improvement in his symptoms.

Clinical case: A 30 years old man (now 48) presented to A&E with painful prolonged erection (priapism). He denied any history of trauma, blood disorders, use of recreational drugs, over the counter drugs or similar symptoms in the past. He had not noticed any change in his libido and was married for previous 6 years. Testosterone was 18.2 (7.8–31 nmol/l). He received the standard treatment by urology team with blood drainage from penis and pseudo-ephedrine injection. Detumescence was achieved with this treatment. His penile doppler confirmed high flow priaprism with flow reaching 60 cm/s. He presented a few more times to A&E with similar complaint and doppler confirmed high flow priapism. He was commenced on cyproterone acetate for control of his stuttering priapism. His symptoms of priapism were well controlled with cyproterone acetate 50 mg four times a week earlier on during his treatment but now 25 mg three times a week is sufficient. His testosterone remains in the low normal range or slightly below the normal range (latest 5.6 nmol/l) with no systemic symptoms. His DEXA scan showed T score at hip 1.3 and at spine 2.0. He continues on cyproterone acetate with good control of his symptoms.

Conclusion: We present here the presentation and management of a patient with stuttering priapism. Different treatments have been tried with variable response. In the absence of randomised controlled trials the best treatment option still remains under discussion for such patients.