Endocrine Abstracts

JOINT3909

Introduction: Gynecomastia is a common clinical phenomenon that can result from various etiologies. Although it is generally linked to hormonal imbalances, gynecomastia can sometimes be associated with less obvious causes, such as paraneoplastic disorders. We report the case of a patient who presented with painful gynecomastia related to paraneoplastic hyperestrogenism.

Case presentation: A 68-year-old male patient was referred to the Endocrinology Department for painful gynecomastia that had been evolving for one year. He gives a history of lung adenocarcinoma, classified as T4N0M0, and he was undergoing chemotherapy with four cycles of Navelbine and Cisplatin. Hormonal testing showed marked hyperestrogenism, with normal levels of FSH, LH, testosterone, prolactin and β-HCG. The course of the condition was marked by the persistence of painful gynecomastia and persistent hyperestrogenism despite analgesic treatment and cessation of chemotherapy.

Discussion and conclusions: This case highlights the importance of investigating all possible causes of gynecomastia, including drug-related causes such as chemotherapy agents. Our patient had received Cisplatin and Navelbine, the adverse effect of which could be painful gynecomastia, but the symptoms persisted even after stopping chemotherapy. Patients with lung cancer and gynecomastia as a paraneoplastic syndrome have a frequency of approximately 2.4%. Gynecomastia is usually caused by an increased estrogen/androgen ratio, elevated serum levels of b-HCG, or an elevated level of prolactin. Our patient had a normal b HCG, a normal prolactin level, and a very high estrogen level which argues in favor of paraneoplastic hyperestrogenism.