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Endocrine Abstracts (2014) 35 P246 | DOI: 10.1530/endoabs.35.P246


1St Spiridon Hospital, Iasi, Romania; 2University of Medicine and Pharmacy, Iasi, Romania.

We present the case of 13 years old boy referred to our service in June 2013 for bilateral gynecomastia (appeared for ~1 year). The boy’s father presented delayed puberty (at 18-year-old). No other pathological hereditary conditions were reported.

Clinical examination revealed: gynoid status with height =167 cm (−1.4 DS), weight=63.5 kg, important bilateral gynecomastia with hypo pigmented areola and painful palpation. Sexual development was PII–PIII with testicular volume=4–5 ml and penis dimensions=6–7 cm.

Hormonal profile: testosterone =0.2 ng/ml, FSH=0.876 mUI/ml, LH=0.119 mUI/ml suggestive for a hypo gonadotrophic hypogonadism or prepubertal status. To differentiate a hypothalamic from a pituitary cause, the LHRH stimulation test was performed. Results revealed FSH and LH levels of 2.00 mUI/ml, 7.17 mUI/ml at 30 min. and levels of FSH=2.04 mUI/ml, LH=5.02 mUI/ml at 45 min suggestive for a hypothalamic hypogonadism. A positive test can also be found in delayed puberty.

Other etiologies of gynecomastia were ruled out by: negative test Barr and normal karyotype analysis (46 XY), normal testicular ultrasound and free β hCG levels, normal thyroid function, prolactin and estradiol levels, as well by the normal hepatic function. We also performed IRM exploration with no hypothalamic or hipophysis lesions.

After 3 months of treatment with tamoxifen the clinical status revealed: H=170 cm, persistent gynecomastia, but normal testicular volume (8 ml) with a normal hormonal profile: testosterone=176 ng/dl, FSH=1.87 mIU/ml, LH=1.07 mIU/ml. The initial hypothesis of hypogonadism was ruled out.

Case particularities: i) A very small number of cases of prepubertal male gynecomastia were reported.

ii) Could the pick of sexual hormones from the LHRH stimulation test triggered puberty?

iii) The normal levels of sexual hormones from the LHRH stimulation test didn’t exclude a hypothalamic etiology.

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