Endocrine Abstracts

Introduction: Gynecomastia is a frequent reason for endocrinology consultation and its correct investigation is pivotal towards a precise diagnosis. We present a clinical case of a rare cause of gynecomastia.

Case report: A 56-year-old male was referred to the hospital setting for an endocrinology consultation. He noticed increased breast size for a year, initially tender to palpation, and unquantified weight loss. Neither galactorrhea, nor any nipple discharges were observed. He reported no decreased libido and no erectile dysfunction. On further history assessment, medication was irrelevant and no nonprescription medications, anabolic steroids and dietary supplements were taken. Past history was negative, except for mumps in his childhood. He had four children, all healthy. On physical examination, body mass index was 26 kg/m² and hair distribution was normal, with beard. Breast examination revealed bilateral retroareolar gynecomastia and on testicular examination, both testes were found in the scrotal pouch, with approximate sizes of 20 ml (right) and 12 ml (left). Hormonal assessment demonstrated only a slight elevation of estradiol. Tumour markers were normal. Scrotal ultrasound revealed a hypoechoic, hypervascularized nodule, 3 cm in size, within the right testicle. Patient was referenced for urology consultation, where testicular biopsy was performed, revealing Leydig cell carcinoma. After right orchiectomy, regression of gynecomastia was observed.

Conclusion: This case report illustrates the importance of a complete medical history, with a good physical examination, and an adequate workup management, to avoid underestimation of rarer, but potentially more severe causes of gynecomastia.