Endocrine Abstracts

Introduction/Aim: Transgender people often worry about side effects of their hormonal therapy, including breast cancer, which is an exceedingly rare occurrence. Hereby we present the case of a patient with an uncommon metadiabetic complication that can be easily confused with breast cancer, with the aim of raising awareness on this condition.

Material and Methods: Review of the Clinical Record of the patient and of the relevant literature.

Results: A 26 year old male-to-female transgender patient had been treated with antiandrogenic (oral cyproterone acetate) and estrogenic therapy (oral and transdermic 17-β-estradiol) since her 14th birthday, and had often self-medicated with higher than recommended doses. She was diagnosed with type 1 diabetes at the age of 12, but she was often careless with her diet and insulin treatment, omitting most of her fast-insulin doses although rarely the daily basal insulin. Her HbA1C was usually in the 10–12% range, in spite of having access to intensive diabetic education; she skipped most of the scheduled appointments and repeatedly rejected insulin pump therapy. She had developed diabetic non-proliferative retinopathy, with multiple microaneurysms, and mild diabetic cheiroarthropathy, with no other known chronic complications. In a routine visit she was visibly anguished about a lump she had noticed in her left breast in the last few months. It was easily palpable but adhered, painless, rock-hard, and about 3 cm in diameter, with no other palpable lesions in the breasts and armpits. Fine needle aspiration cytology was attempted on the spot, but the lesion was too hard and no sample could be attained; a TruCut core biopsy was performed a week later and the final diagnosis was fibroinflammatory mastitis (diabetic mastopathy). The patient was reassured that this was a benign lesion and that surgery was unwarranted. The available literature suggest that hormonal therapy in transgender people is not associated with increased risk of any type of malignancy.

Conclusions: Diabetic mastopathy is an unusual metadiabetic complication, typically diagnosed in female diabetic patients with a long history of poor metabolic control (exceptionally in males). It has never been before reported (in our knowledge) in a transgender patient. It is a benign condition usually not requiring surgery, but clinically indistinguishable from breast carcinoma, which may lead to unnecessary anxiety or intervention. Cancer-anxious transgender patients may be reassured that their hormonal therapy is not associated with increased malignancy risk.