KALLMANN SYNDROME AND SURGERY FOR GYNECOMASTIA

D.N. Păduraru; Oana Botezan; Alexandra Bolocan; O. Andronic; Andra Morar; Cristina Moldovan; Alexandra Ene; B. Socea; Roxana Turturea; Mara Carsote; Ana Valea

D.N. Păduraru 1General Surgery Department and Emergency III, University Emergency Hospittal of Bucharest, Romania 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Oana Botezan 3County Clinical Hospital, Cluj-Napoca, Romania
Alexandra Bolocan 1General Surgery Department and Emergency III, University Emergency Hospittal of Bucharest, Romania 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
O. Andronic 1General Surgery Department and Emergency III, University Emergency Hospittal of Bucharest, Romania 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Andra Morar 4Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania
Cristina Moldovan 3County Clinical Hospital, Cluj-Napoca, Romania
Alexandra Ene 3County Clinical Hospital, Cluj-Napoca, Romania
B. Socea 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 5Clinical Emergency Hospital “Sf. Pantelimon”, Bucharest, Romania
Roxana Turturea 3County Clinical Hospital, Cluj-Napoca, Romania
Mara Carsote 6C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
Ana Valea 3County Clinical Hospital, Cluj-Napoca, Romania 7I. Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

Keywords: Kallman syndrome, gynecomastia, anosmia

Abstract

Kallmann syndrome (KS) is the most common genetic form of isolated gonadotropin deficiency, more often encountered in males than in females. There are many types of KS, depending on the responsible gene mutation. By definition, either anosmia or hyposmia is present in patients with KS, but some clinical forms may associate gynecomastia. We present the case of an11-year-old male patient who was admitted for painful bilateral gynecomastia, anosmia and moderate asthenia. Clinical examination revealed normal height, normal body proportions, Tanner puberty stage 1. The hormonal profile revealed low gonadotropin levels: FSH (Follicle-Stimulating Hormone) of 0.33 mU/mL (normal: 1.27-19.3 mU/mL), LH (Luteinizing Hormone) of 0.14 IU/L (normal: 1.24-8.62 IU/L), low serum testosterone (of 0.20 ng/mL, normal: 1.68-7.58ng/mL), normal prolactin and estrogen levels. Breast ultrasound detected the presence of bilateral abnormal proliferation of fibroglandular tissue: 3 cm on the left side and 4 cm on the right side. The MRI (Magnetic Resonance Imaging) scan did not find pathological changes in the hypothalamic and pituitary region. Testosterone therapy was initiated at the age of 13, followed by surgical cure of gynecomastia at the age of 17. Periodic monitoring of serum total testosterone, PSA (Prostate-specific Antigen), prostate ultrasound and complete blood count were recommended.Gynecomastia in KS may present as a clinical sign or as a complication of testosterone therapy, along with polycythemia and the increased risk of prostate cancer

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