PRIAPISM AS A COMPLICATION OF HIGH DOSE TESTOSTERONE THERAPY IN A MAN WITH HYPOGONADISM

Abstract

A 23-year-old man presented with the chief compliant of failure to grow facial hair. Physical examination revealed no facial hair, penis smaller than normal for age, bilateral testicular atrophy, no gynecomastia, and pubic and axillary hair. Serum testosterone was 0.88 nmol./l. (normal 10.4 to 41.6), luteinizing hormone 41 IU/l. (normal 6 to 30), folliclestimulating hormone 37 IU/l. (normal 4 to 25) and prolactin 15 mg./l. (normal 1 to 20). Diagnosis was hypergonadotropic hypogonadism. Treatment was instituted with 250 mg. testosterone enanthate intramuscularly every 2 weeks. At the fourth injection 2 ampules (500 mg.) of testosterone were given at the urging of the patient to achieve “better results.” He received that injection at 10 a.m. Erection from 10 p.m. that day lasted until presentation to the emergency room 36 hours later. On examination there was severe priapism that failed to respond to aspiration and injection of adrenaline. A corporeal glandular shunt was performed. Dark blood aspirated intraoperatively suggested low flow priapism. Complete detumescence was achieved 17 hours postoperatively. The patient resumed biweekly testosterone injections 2 months postoperatively without priapism. At 16-month followup the only side effect was slight facial acne. DISCUSSION