Abstract
A 14-yr-old boy developed spectacular gynecomastia in association with pubescent growth and rapid sexual maturation. Histologic examination of the testis disclosed plump active Leydig cells and accompanying spermatogenesis. Breast tissue was like that usually seen in gynecomastia and did not contain detectable quantities of the specific 8S estradiol binding protein and also failed to convert testosterone to dihydrotestosterone. The plasma concentration of testosterone was consistently above the range observed in normal men and other pubertal boys. The plasma estradiol concentration was proportionately elevated. Adrenocortical steroids were present in normal amounts. Plasma FSH and LH concentrations were also within the normal range. Testosterone and estradiol concentrations rose with chorionic gonadotropin therapy, but the testosterone level was not suppressed by treatment with prednisone or fluoxymesterone. It was concluded that the gynecomastia was the result of elevated levels of testicular sex hormones. This hyperleydigism was explained on the basis of a failure of the negative hypothalamic-pituitary feedback system to respond appropriately to circulating testosterone and estradiol.
Published Version
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