Endocrine Abstracts

Introduction

Although addressability for breast pathology is much lower in men than in women, the underlying causes of the initial complaints are often much more spectacular. Gynecomastia is one of the principal reasons for addressing the endocrinologist and next to the important psychosocial impact, sometimes it seems to be only the tip of the iceberg, revealing important underlying medical conditions.

Case reports

We present the cases of two male patients who addressed our clinic for gynecomastia. The first case is of a male patient, aged 40, who addressed our service for a painful right breast nodule, appeared 2 weeks prior to the presentation. The patient reported having two other similar episodes in Maroc, 7 years ago and 1 year ago, considered to be infectious mastitis and treated by antibiotics. Only regular blood tests were performed during the previous episodes, with no hormonal profile and no imaging or histopathological studies. The physical evaluation at the current presentation revealed a painful nodule in the upper external quadrant of the right breast. Laboratory evaluation revealed important hyperprolactinemia and hypogonadotropic hypogonadism, with normal liver, renal and thyroid tests. The ultrasound revealed bilateral gynecomastia, with no tumoral process. The testicular ultrasound was normal. The pituitary MRI revealed a microadenoma measuring 6.3/5/6 mm. The patient was initiated on dopamine-agonist therapy and the prolactin level returned to normal within 2 months. The second case is of a male patient, aged 65, who was hospitalized for atypical chest pain. The physical examination revealed bilateral gynecomastia, reported by the patient as being present from his early 20s. After complete cardiac evaluation, he was addressed to us. The laboratory evaluation revealed hypergonadotropic hypogonadism. The ultrasound revealed bilateral gynecomastia with an ACR4 area of 11.5/9.5/10 mm in the left breast, with no pathological adenopathy. The percutaneous biopsy performed showed discrete fibrocystic dysplasia. The testicular ultrasound found small, hypervascularised testes with microcalcifications. The karyotype performed showed a Klinefelter syndrome mosaicism 46, XX/47, XXY. The osteodensitometry revealed femoral osteopenia. The patient was initiated on testosterone substitutive therapy and vitamin D and calcium supplementation.

Conclusion

Although in more than 50% of cases gynecomastia is idiopathic, complete clinical, biochemical and imaging assessment is required in order to exclude rare or life-threatening conditions. Initiation of adequate treatment, when needed, will have a high impact on patient satisfaction and on the outcome, preventing possible serious complication, as those associated with hypogonadism, neoplasia, liver or renal diseases.