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hCG test in gynaecomastia: further study
J M Kuhn1, Y Reznik, J A Mahoudeau
1Service d'Endocrinologie, CHU Rouen, Bois Guillaume, France.
Clinical Endocrinology
|November 1, 1989
Summary
A prolonged oestradiol response to hCG aids in diagnosing Leydig cell tumors (LCT) in men with gynaecomastia. Combining this with gonadotrophin levels significantly improves diagnostic specificity for LCT.
Area of Science:
- Endocrinology
- Reproductive Medicine
- Oncology
Background:
- Gynaecomastia in adult men can be caused by various conditions, including Leydig cell tumors (LCT).
- Assessing hormonal responses, particularly oestradiol (E2) after human chorionic gonadotropin (hCG) stimulation, has been proposed for LCT diagnosis.
- The specificity of the prolonged E2 response to hCG for LCT diagnosis remains uncertain.
Purpose of the Study:
- To evaluate the diagnostic utility and specificity of the prolonged plasma oestradiol (E2) response to human chorionic gonadotropin (hCG) in adult men with gynaecomastia.
- To compare hormonal profiles, including gonadotrophins and testosterone, in men with LCT, isolated gynaecomastia, hypogonadism, and controls.
- To determine if combining E2 response with gonadotrophin patterns enhances LCT diagnostic accuracy.
Main Methods:
- Hormonal status (E2, testosterone, gonadotrophins) was assessed in 85 men with gynaecomastia (17 LCT, 52 isolated gynaecomastia, 16 hypogonadal) and controls.
- Hormonal responses to hCG (5000 IU i.m.) or GnRH (100 micrograms i.v.) administration were measured.
- Basal and stimulated gonadotrophin levels and E2 responses were analyzed and compared across groups.
Main Results:
- All 17 patients with LCT exhibited a prolonged E2 response (>300 pmol/l on day 3 post-hCG).
- Prolonged E2 response was also observed in some patients with isolated gynaecomastia (10/21) and Klinefelter's syndrome (3/13), but rarely in those with normal gonadotrophin parameters (1/13).
- Gonadotrophin levels were significantly higher in Klinefelter's syndrome and EGG (elevated gonadotrophin group) isolated gynaecomastia compared to controls, but similar in LCT and controls.
Conclusions:
- A prolonged E2 response to hCG alone is not specific for diagnosing feminizing Leydig cell tumors (LCT).
- Integrating gonadotrophin patterns (basal and GnRH-stimulated) with the prolonged E2 response significantly improves diagnostic specificity for LCT from 80% to 98%.
- This combined hormonal assessment offers a more reliable method for differentiating LCT in men presenting with gynaecomastia.