Endocrine Abstracts

Introduction: Gynecomastia is a relatively common reason for consultation, with a high prevalence in the neonatal period, puberty and with aging. The diagnostic approach should be more thorough in normal-weight individuals with recent onset of gynecomastia, rapid growth of breast tissue, or in the setting of a large painful breast. Besides the evaluation of liver function, testosterone, estradiol, LH and β-hCG, testicular ultrasound evaluation is important to exclude testicular tumors. The prevalence of testicular microlithiasis (TM) is about 2.4% in assyntomatic boys, and increases with age. It is usually found in isolation, but in 30 to 40% of cases, it is associated with testicular germ cell tumor or its precursor carcinoma in situ.

Case report: A 21-year-old male was referred for endocrinology consultation for unilateral left gynecomastia, which had begun 8 months earlier. His PRL levels were also increased in isolated assay (401 mIU/ml (86–324)). He had a history of bilateral gynecomastia at puberty, which had fully recovered. A painless enlargement of the left breast, without any palpable nodules, was noticed. Physical examination was otherwise unremarkable. Mammary ultrasound showed left mammary gland hyperplasia, without any nodule. PRL increase was not confirmed in multiple catheter samples (20.0–18.6–16.6 ng/ml at 0, 20 and 40 min, respectively (4.0–18.4)). FSH (2.64 (1.1–13.6) mIU/ml), LH (3.78 (1.1–8.8) mIU/ml), total testosterone (4.16 (1.7–8.7) ng/ml), estradiol (35.0 (11–44) pg/ml), liver tests and and β-hCG (<1.2 (0–5) mIU/ml) were normal. Testicular ultrasonound scan showed bilateral testicular microlithiasis with no suspicious nodules. The patient remains in regular clinical and imaging follow-up.

Conclusions: Despite the association between TM and testicular germ cell tumor, the malignant potential of the former is not yet completely understood. There is also no consensus on the best follow-up strategy for patients with TM, but it is nevertheless important to identify those with at least one risk factor for testicular germ cell tumor.