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Changes in estradiol and testosterone secretions in man with leydigioma and after removal of the tumour
Article published in Urologia Polska 2003/56/2.


Elżbieta Oszukowska 1, Jolanta Słowikowska-Hilczer 1, Marek Lipiński 2, Krzysztof Kula 1
1 Zakład Andrologii i Endokrynologii Płodności, Instytut Endokrynologii w Łodzi Kierownik zakładu: prof, dr hab. Krzysztof Kula
2 Klinika Urologii, Instytut Chirurgii Uniwersytetu Medycznego w Łodzi Kierownik kliniki: prof, dr hab. Leszek Jeromin


testis, leydigioma, testosterone, estradiol, human chorionic gonadotropin, hCG


The patient DC came to the clinic because of bilateral gynaecomastia. Normal consistency and volume of the testes were found. There were a low level of testosterone in the blood and a high level of estradiol. A test with human chorionic gonadotropin (hCG) was performed to exclude ectopic secretion of estradiol. The testicular origin of the hormone was revealed by the level of estradiol at each of the examined time-points (24. 52, 72, 96 hours), which was respectively 5.6:8.5:9 and 10 times higher than in healthy men, while concentrations of testosterone at each of the examined time-points were lower than in healthy men. Testicular localisation of the tumour was confirmed by ultrasound. Hemicastration of right testis was performed and a tumour of Leydig cells was diagnosed. The concentration of estradiol did not return to normal values just alter the operation (2 months) but after a delay (10 months). Normalization of the blood level of estradiol and lowered response to hCG coexisted with still decreased secretory response of testosterone to hCG, as before the operation.
1. Increased estradiol and decreased testosterone secretory responses to hCG in a patient with leydigioma suggest that excessive estradiol production causes inhibition of testosterone secretion by the testis. This may be important in the pathogenesis of leydigioma.
2. After the removal of leydigioma the Leydig cells still show decreased secretion of testosterone (together with lowered secretory reserve of estradiol).
3. It seems that hCG test in men is important, in the diagnosis of hyperestrogenism because it indicates the gonadal localisation of the hor-monally active tumour. Repetition of the test after the operation discloses changes in the dynamic of the secretory activity of the remaining testis.


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Krzysztof Kula
Zakład Androtogii i Endokrynologii Płodności LIM
ul. S. Sterlinga 5
91-425 Łódź
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