Endocrine Abstracts

Gynaecomastia in elderly males is relatively common and could be due to age-related endocrinological and metabolic disorders, drugs and other medical conditions. We report on the case of a 72 year old male smoker who presented with a 10 month history of painful unilateral gynaecomastia, lethargy and weight-loss. He had a past medical history of type 2 diabetes, atrial fibrillation, ischaemic heart disease, hypertension, stroke and monoclonal gammopathy. He was taking Clopidogrel, Aldalat and Candesartan at home. He had previously been on Digoxin and Finasteride, which were discontinued several months ago. Examination showed a 3cm left breast lump and normal testes. Initial investigations revealed a normocytic, normochromic anaemia (haemoglobin 10.6 grams per decilitre) with normal erythrocyte sedimentation rate, liver function tests, calcium, prolactin and insulin-like growth factor-1. Leutinising hormone and Follicle stimulating hormone were slightly raised at 17.5 and 17.6 international units per litre respectively, with normal testosterone (13.5 nanomoles per litre), oestradiol (91 picomoles per litre) and cortisol (297 nanomoles per litre). Beta human chorionic gonadotrophin level was within normal range. Magnetic resonance imaging of the pituitary gland was normal.
During follow-up for monoclonal gammopthy, computed tomography scan of the thorax revealed a right hilar mass, consistent with bronchogenic carcinoma. The patient was referred to the oncologist and is currently undergoing palliative radiotherapy.
Gynaecomastia is a rare non-metastatic extrapulmonary manifestation of bronchogenic carcinoma. It may result from various endocrine dysfunctions and often reflects ectopic production of hormones. This case report underlines the necessity of an intensive search for underlying malignancy, especially in elderly patients presenting with gynaecomastia or other such endocrine conditions.