madman
Super Moderator
CASE DESCRIPTION The laboratory obtained a testosterone result of 30 117 ng/dL for a 51-year-old man and called the medical director to assess whether this value was feasible because it would represent the highest testosterone concentration ever reported by the laboratory. The patient was an avid runner with a history of a right testicular mass and orchiectomy 10 years previously. The patient was supplemented with testosterone cypionate (200 mg/2 weeks). The results for follicle stimulating hormone and luteinizing hormone were unremarkable.
QUESTIONS
1. What conditions are associated with the extremely high testosterone concentrations?
2. Could exogenous testosterone account for this concentration?
3. If pathological, what is the prognosis for patients with this condition?
ANSWER
Increased testosterone concentrations are seen in individuals with exogenous testosterone supplements and sex hormone–producing adrenal tumors. At supraphysiological doses, exogenous supplements could raise serum testosterone concentrations by approximately 2- to 6-fold (1–3).This patient had a metastatic Leydig cell tumor diagnosed 5 years post orchiectomy. Testosterone concentrations began to increase dramatically around this time (Fig. 1). Malignant Leydig cell tumor is refractory to chemotherapy and radiotherapy (4). The median survival time of patients with malignant Leydig cell tumor is 2 years (5).
QUESTIONS
1. What conditions are associated with the extremely high testosterone concentrations?
2. Could exogenous testosterone account for this concentration?
3. If pathological, what is the prognosis for patients with this condition?
ANSWER
Increased testosterone concentrations are seen in individuals with exogenous testosterone supplements and sex hormone–producing adrenal tumors. At supraphysiological doses, exogenous supplements could raise serum testosterone concentrations by approximately 2- to 6-fold (1–3).This patient had a metastatic Leydig cell tumor diagnosed 5 years post orchiectomy. Testosterone concentrations began to increase dramatically around this time (Fig. 1). Malignant Leydig cell tumor is refractory to chemotherapy and radiotherapy (4). The median survival time of patients with malignant Leydig cell tumor is 2 years (5).
