Feminizing Testicular Leydig Cell Tumor: Hormonal Profile before and after Unilateral Orchidectomy*

Abstract

The effect of chronic hyperestrogenism on gonadal function was studied in three men who had estrogen-secreting Leydig cell tumors before unilateral orchidectomy and for 11-43 months after surgery. All three men had low plasma gonadotropin and testosterone levels and increased estradiol levels. Impairment of testicular steroidogenesis was also suggested by increased progesterone to 17-hydroxyprogesterone and 17-hydroxyprogesterone to androstenedione ratios in both spermatic venous plasma and the medium of Leydig tumor cells from one patient incubated in vitro. Before surgery, spermatogenesis was abnormal in two men. Testicular endocrine function and spermatogenesis did not return to normal after surgery. During the follow-up period, plasma gonadotropin levels were high in all three men, and testosterone was low normal. Estradiol levels decreased to normal immediately after surgery and then returned to the upper normal limit. The response to hCG stimulation in one man was subnormal. We conclude that chronic hyperestrogenism produced hypothalamo-pituitary inhibition as well as direct steroidogenic blockade at the testicular level. Long term impairment of both endocrine and exocrine testicular functions may be secondary to slowly reversible (or irreversible) estrogen-induced damage to tubular and Leydig cells.

Levels of estradiol and testosterone are altered in Chinese men with sexual dysfunction

“…Given adipose tissue is a crucial source of aromatization of testosterone, obesity should be a certain cause of hyperestrogenism. In addition, endogenous E 2 -T ratio increase is a clinical characteristic of several conditions, including chronic liver diseases, type II diabetes mellitus, hypercholesterolemia, Klinefelter syndrome, and tumors of Leydig cells or adrenal cortex (Mineur et al, 1987;Stremmel et al, 1988;Oettel, 2002). Exogenous factors that affect E 2 -T homeostasis include various environmental agents and plant estrogens, such as xenoestrogens and phytoestrogen (Oliva et al, 2002;Srilatha & Adaikan, 2004).…”

Leydig cell tumor of the testis presenting with gynaecomastia due to hyperprolactinemia after orchiectomy

“…This finding is not surprising as previous studies have shown discrepancies of oestrogen levels at different locations with levels at spermatic veins being about 6,000 times superior compared to serum levels. [26][27][28] The higher values at testis level indicate that even the remaining leydig cells in the remaining testis are dysfunctional resulting to endocrine manifestations as seen in our patient. We don't have the capacity to measure oestrogen level at spermatic veins in our facility; hence high oestrogen level though more likely could not be confirmed.…”

Testicular Adrenal-Like Tissue in a Patient with 17α-Hydroxylase Deficiency

“…The cell origin of TALT is debatable; adrenal cortical rest cell [15], Leydig cell. including hilus cell [16,17] and putative pluripotential cell of the hilus [18, 19J have been considered. A recent study by Clark et al [20] on in vitro steroidogenesis and receptors of testicular masses in a patient with CAH has demonstrated that the tissue of these testicular masses was of adrenal origin.…”