Endocrine Abstracts

Case history: Adrenal masses are often a diagnostic challenge and can present with unusual symptoms. We describe a case of a 37-year-old male with a background of ulcerative colitis, who presented with bilateral gynecomastia in the breast clinic of, worsening over last one year. He had marked breast tenderness, a decline in his libido but no erectile dysfunction. There was no history of recreational drug use.

Investigations: His serum biochemistry showed a persistently elevated oestradiol and with low testosterone and FSH. His prolactin day curve was within normal limits. Ultrasound testes and MRI pituitary were normal. Subsequently, a CT adrenal showed well defined, enhancing tumour arising from the left adrenal gland measuring 5 cm in the maximum axial dimension. PET-FDG confirmed hypermetabolic tumour on the left adrenal with no distant metastasis.

Results and treatment: Testosterone 2(6–27) nmol/Lit; FSH 0.20(1–9) IU/l; Oestradiol 331(0–116) pmol/l. A diagnosis of oestradiol secreting adrenal tumour was made, and the patient is listed for urgent surgery. Results of histology will be available after the surgery.

Conclusions and points for discussion: Adrenal masses are often a diagnostic challenge and can present with unusual symptoms such as gynecomastia.

• We will discuss rarer causes of gynecomastia including mutations in the CYP19A1 gene (aromatase overactivity), feminising Sertoli cell tumours along with feminising adrenal tumours (FAT).

• We will review the current literature for FAT and describe its prevalence, clinical presentation, investigations, treatment options and prognosis.