Endocrine Abstracts

Introduction: Gynecomastia is a condition characterised by the benign proliferation of breast tissue growth in males. Among variety of causes, 3% of cases are due to testicular tumours. [1]. We present a 35-year-old male, who had elevated estradiol levels and gynecomastia, who was found to have a Leydig cell tumour.

Case Presentation: A 35-year-old male was referred to our clinic with 3 month history of bilateral breast growth. He had no significant medical history, non-smoker, and consumed 4 to 5 cans of beer per week. He did not take any regular medications. He reported that he had been going to the gym and taking protein supplements for muscle building about 6 to 8 weeks before the onset of symptoms. He denied using testosterone, androgens, or anabolic steroids. On examination, he had a BMI of 22.5 kg/m^2 and a masculine build with normal secondary sex characteristics. He had symmetrical bilateral gynecomastia, characterized by enlarged and tender glandular tissue. On two occasions, 4 months apart, he had elevated estradiol levels. The testicular examination was normal, with no palpable nodularity or inguinal lymphadenopathy.Blood Test ResultsTesticular ultrasound was requested, demonstrating a 14 mm upper pole mass of the right testis with heightened vascularity on colour Doppler. The patient subsequently underwent a right orchidectomy, and the histopathology report confirmed a Leydig Cell Tumor. CT TAP showed no evidence of metastatic disease.

Discussion and Conclusion: Leydig Cell Tumors are usually unilateral neoplasm that arise from the gonadal stroma. The majority of Leydig Cell Tumours secrete the hormones testosterone and estrogen. [2] They are rare tumours which mainly affect men in the age range of 20-60 years old and normally present with negative tumour markers. [3]. Orchiectomy is curative in approximately 90% of cases. [4] In conclusion, it is critical for endocrinologists to consider the possibility of Leydig Cell tumors, especially in young men who present with unexplained raised estradiol levels and gynecomastia. The key to management is to maintain a low threshold for performing testicular ultrasound, even in cases with normal physical examination findings and negative tumor markers. Early diagnosis and prompt treatment are essential for favorable outcomes.

References: [1] Braunstein GD. Gynaecomastia. N Engl J Med 1993; 328: 490±5.

[2] Gheorghisan-Galateanu, A.A. Leydig cell tumors of the testis: a case report. BMC Res Notes 7, 656 (2014)

[3] Osama M. Al-Agha, MD; Constantine A. Axiotis, MD Arch Pathol Lab Med (2007) 131 (2): 311–317

[4] Bertram KA, Bratloff B, Hodges GF, Davidson H: Treatment of malignant Leydig cell tumor. Cancer. 1991, 68: 2324-2329. 10.1002/1097-0142(19911115)68:10<2324::AID-CNCR2820681036>3.0.CO;2-K