Thomas Sunil Raj, Evans Peter J, Holland Philip A, Biswas Moushmi
Department of Diabetes and Endocrinology, Royal Gwent Hospital, Newport, Gwent, United Kingdom.
Endocr Pract. 2008 Mar;14(2):201-3. doi: 10.4158/EP.14.2.201.
To alert fellow endocrinologists of a rare side effect of testosterone therapy, for which men with hypogonadism must receive appropriate counseling and monitoring.
We present clinical features, laboratory data, and histopathologic findings in a man with hypogonadism who received testosterone replacement therapy.
A 61-year-old man was referred to an endocrinologist after presenting to his general practitioner with erectile dysfunction and low libido. He had no history of hypothalamic, pituitary, or testicular disorders. There were no other illnesses or medications to account for low testosterone levels. Physical examination was unremarkable. There was no family history of malignant disease. Biochemical investigations confirmed the presence of primary hypogonadism, for which no cause (including Klinefelter syndrome) was identified. Testosterone therapy was initiated to improve sexual function and preserve bone density. Five weeks later, the patient returned to his general practitioner, complaining of a gradually enlarging lump in his right breast. When biopsy showed breast cancer, testosterone therapy was discontinued. Right mastectomy and axillary node clearance were performed. Further histologic examination revealed estrogen receptor-positive, invasive carcinoma, without nodal involvement. The patient remains on tamoxifen therapy and is undergoing follow-up in the breast clinic. After 6 months of treatment, estradiol levels were undetectable, and testosterone levels remained low.
Although breast cancer has been described in men with hypogonadism receiving long-term testosterone replacement therapy, to our knowledge this is the first report of breast cancer becoming clinically manifest after a short duration (5 weeks) of testosterone treatment. This case should remind clinicians that men receiving testosterone therapy should be warned of the risk of not only prostate cancer but also breast cancer. Patient self-monitoring and breast examinations by the attending physician are recommended.
提醒内分泌科同行注意睾酮治疗的一种罕见副作用，性腺功能减退的男性必须接受适当的咨询和监测。
我们呈现了一名接受睾酮替代治疗的性腺功能减退男性的临床特征、实验室数据和组织病理学结果。
一名61岁男性因勃起功能障碍和性欲低下就诊于全科医生后，被转诊至内分泌科医生处。他无下丘脑、垂体或睾丸疾病史。没有其他疾病或药物可解释睾酮水平低下。体格检查无异常。无恶性疾病家族史。生化检查证实存在原发性性腺功能减退，未发现病因（包括克兰费尔特综合征）。开始睾酮治疗以改善性功能并维持骨密度。五周后患者返回全科医生处，抱怨右乳肿块逐渐增大。活检显示为乳腺癌后，停用睾酮治疗。进行了右乳房切除术和腋窝淋巴结清扫术。进一步的组织学检查显示为雌激素受体阳性浸润性癌，无淋巴结受累。患者继续接受他莫昔芬治疗，并在乳腺门诊接受随访。治疗6个月后，雌二醇水平检测不到，睾酮水平仍低。
虽然在接受长期睾酮替代治疗的性腺功能减退男性中曾有乳腺癌的报道，但据我们所知，这是首例在短时间（5周）睾酮治疗后乳腺癌临床表现出来的报告。该病例应提醒临床医生，接受睾酮治疗的男性不仅应被告知前列腺癌的风险，还应被告知乳腺癌的风险。建议患者自我监测并由主治医生进行乳房检查。
