Sudden and unusual onset of penile plastic induration in 2 patients neurosurgically treated for pituitary macroadenoma

: Induratio penis plastica (IPP) or Peyronie disease is characterized by the developing of fibrotic plaques in the tunica albuginea of penis, that in the latter stages can lead to impotence. The etiology of this disease is still unknown even if various factors such as inflammation, autoimmunity or traumas are involved. Usually it occurs after 40 years of age, even if cases in young patients have been described. The onset of IPP can be acute in about 50% of the patients, while in the others it is characterized by a chronic but progressive progress. In this work, we describe the cases of two patients 52 and 66 years old, who arrived to our department for a decrease of libido and sexual potency in the last months. The patients were not smokers and took no drugs and they had never complain symptoms and signs of IPP. In both subjects an endocrine pattern compatible with partial hypopituitarism was present and in the first patient it was associated with an ACTH-dependent hypercortisolism. Pituitary imaging with MRI showed in both patients the presence of a mass compatible with macroadenoma, that in the first patient showed characteristic of invasiveness. Both subjects underwent transphenoidal neurosurgery with the exeresis of the neoplasia, with resolution of the secondary hypogonadism and reappearance of the sexual potency. With the resume of sexual activity the patients complained the appearance of painful penis bending during erection. Dynamic echographic evaluation of the penis with 7.5 Mhz linear probe, after the intracavernous injection of prostaglandin E1 10 micrograms, showed in both patients the presence of a hyperechogenic plaque in the tunica albuginea compatible with IPP. Both patients underwent successfully surgery for the excision of the plaque and the apposition of a patch of dura mater. The authors want to underlie as the onset of IPP can be sudden, promoted by the resolution of the hypogonadism secondary to pituitary neoplasia, and contemporary to the normalization of testosterone levels.