Endocrine Abstracts

Introduction: Dupuytren’s disease (DD) corresponds to a chronic palpable thickening of the palmar aponeurosis which leads to different degrees of irreducible flexion of the fingers. It is one of the manifestations of hand syndrome in diabetes mellitus. We highlight through this report the occurrence of DD as a manifestation of diabetic hand syndrome in a patient with type 2 diabetes mellitus.

Observation: A sixty-six year old patient, truck driver, type 2 diabetic for twenty-two years, treated with oral antidiabetics, was admitted for treatment of an aseptic pseudoarthrosis secondary to surgical treatment of traumatic left tibial fracture. Medical history revealed poorly controlled diabetes, polyuro-polydypsia syndrome, and bilateral functional impotence limiting flexion of the first and second fingers. Clinical examination revealed bilateral flexion retraction of the first and second fingers, predominantly in the left hand, associated with palpable thickening of the palmar fascia. The rest of the osteoarticular examination did not reveal any other abnormalities except the fracture site in the left tibial bone. Biologically, the patient had an elevated HbA1c 9.7%, nonproliferative diabetic retinopathy, and chronic kidney disease at the stage of micro albuminuria. The diagnosis of fingers retraction in the context of DD with flexion deformities of the hands secondary to type 2 diabetes was retained. Therapeutic management was based initially on optimising glycaemic control and therapeutic education. Plastic surgery is planned on both hands.

Discussion: DD is a progressive fibrotic disorder of the fascia of the palm and fingers. Nodules and cords fixed to the skin and palmar fascia lead to flexural deformity of the fingers that disable normal movement of the hand, and result in the pathology of Dupuytren contracture. In people with diabetes, It mostly affects the third and fourth fingers, the thumb and the index are rarely involved. Several risk factors have been identified for DD; diabetes, increasing age, male, heavy alcohol consumption and smoking. The prevalence of DD in the diabetic population ranges from 20% to 63% depending on the series, compared to only 13% in the general population. The treatment of DD in diabetic patients does not differ from non-diabetic patients. Good glycaemic control is essential, Treatment can be medical and/or surgical. The decision to treat is guided by the functional discomfort degree.

Conclusion: DD is a fibroproliferative disorder often associated with diabetes and chronic hyperglycaemia. It causes a significant functional handicap requiring a multidisciplinary management.