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endo 2

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kpmle2
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01/10/08 - 03:41 PM

A 32-year-old man presents with enlargement and tenderness of the breasts for 6 months. For about 3 years he has been treated with a β-adrenergic antagonist for hypertension; his blood pressure is 128/82 mm Hg. On physical examination, he has bilateral breast enlargement, but no other detectable abnormalities.
Laboratory studies:
Serum testosterone 600 ng/dL
Serum estradiol 88 pglmL
Serum luteinizing hormone 2.6 mU/mL
Serum follicle-stimulating hormone 1.7 mU/mL
Serum human chorionic gonadotropin 23,500 ng/mL
What is the most appropriate diagnostic test in this patient?
A. Breast ultrasound
B. MRI of the pituitary gland
C. Ultrasonography of the testes
D. Peripheral blood karyotype
E. Serum prolactin measurement

Edited by Aashi on 01/10/08 - 04:09 PM

Aashi
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01/10/08 - 04:07 PM

C. Ultrasonography of the testes

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dr.wad
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01/10/08 - 04:23 PM

cool doctor
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01/10/08 - 04:27 PM

tamerbashir
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01/10/08 - 05:37 PM

OK C

neurom
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01/11/08 - 12:05 PM

suspect a germ cell tumor - C

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Ivonne
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01/11/08 - 12:50 PM

Could someone post the normal range of those hormones. thanks.

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Aashi
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01/11/08 - 01:13 PM

Ivonne wrote:
Could someone post the normal range of those hormones. thanks.

Normal Hormone Values for men

Testosterone 300 - 1100 ng/dl
Prolactin 7 - 18 ng/ml
Luteinising Hormone ( LH) 2 - 18 mIU/ml
Follicle Stimulating Hormone ( FSH): 2 - 18 mIU/ml
Estradiol ( Day 3): < 50 pg/ml

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Ivonne
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01/11/08 - 02:20 PM

Thanks Aashi, i appreciate.

Found testoterone level in UW normal value: 3-10 ng/dl

Edited by Ivonne on 01/13/08 - 02:54 PM

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kpmle2
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01/12/08 - 10:28 AM

#10

The correct answer is C

Recognize that germ cell tumors of the testes produce hCG, and lead to breast enlargement in young men.

Transient gynecomastia is common during puberty, and breast enlargement often occurs in older men. But when painful breast enlargement occurs in young adult men, hormonal stimulation is suspected. Breast enlargement occurs with androgen deficiency or with estrogen excess. In this case the level of hCG is increased markedly. hCG activates the aromatase gene and allows for increased conversion of substrate testosterone to estradiol and of androstenedione to estrone. hOG is usually absent in the plasma in men, and high levels suggest the diagnosis of choriocarcinoma, an aggressive germ cell tumor. These tumors are located either in the testis or in the retroperitoneal space of the abdomen or chest. Although sometimes palpable, tumors of the testis may be too small to be detected by physical examination. Ultrasonography is a reliable and valuable tool in the diagnosis of testicular tumors. Tumors in the chest or abdomen are often evident by CT scanning.

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