Endocrine Abstracts

A 29 year old male and his wife presented with an 18 month history of primary infertility. History and initial investigations suggested no major female component but a semen analysis revealed azoospermia. There was no history of any sexual dysfunction and neither partner was receiving any medication. Clinical examination revealed normal secondary sexual characteristics. Both testicles were of normal consistency with a volume of approximately 15mls but a 4x2cm mass was palpable at the lower pole of left testis. Laboratory investigations revealed: serum testosterone 37.1nmol\/l (10.0-38.0 nmol\/l), LH<0.3U\/L (3.0-12.0 U\/L), and FSH <0.1IU/L (3.0-11.0 U/L). Serum beta-HCG, alphaFP, LDH, oestradiol and inhibin levels were within the normal range. A repeated semen analysis, confirmed azoospermia. Testicular ultrasound demonstrated a well-defined hypoechoic mass, measuring 31x23x17 mm and containing several flecks of calcification, arising from the lower pole of the left testis. A left orchidectomy was performed. Macroscopical histopathological examination revealed a single firm dark brown nodule 2.8 cm in diameter arising from the lower pole of the testis. The tumour appeared to be distending the capsule of the testis but not extending through it. Microscopical examination was consistent with a Leydig cell tumour. Computerised tomography of the chest, abdomen and pelvis was normal. Six months later laboratory investigations revealed a serum testosterone of 14.3 nmol/l, an LH of 5.4U/L and an FSH of 4.3U/L respectively. A repeated semen analysis was normal: volume 1.8 ml (2-10 ml), count 124x10(super)6(/super)(20-350x10(super)6(/super)), motility 80%(>60%), abnormal forms <15%( <15%).Three months later his wife was pregnant. In summary, our patient presented with azoospermia, secondary to a Leydig cell tumour associated with autonomous testosterone secretion, which was reversible after removal of the tumour.