A 32 year old male patient complains of progressive enlargement of breast tissue from last few weeks. O/E painless testicular mass is observed in testis.On hormonal investigations he has low levels of serum LH and testosterone. What might be the cause in such case?

The above symptoms with lab findings points towards a disorder associated with raised primary estrogen levels, such as seoli cell tumor. Here hypogonadotropic hypogonadism have to be excluded before making the above diagnosis. Gynecomastia Any cause of androgen deficiency can lead to gynecomastia, reflecting an increased estrogen/androgen ratio. Gynecomastia is a characteristic feature of Klinefelter syndrome Androgen insensitivity disorders also cause gynecomastia. Excess estrogen production may be caused by tumors:- including Seoli cell tumors in isolation or in association with Peutz-Jegher syndrome or Carney complex. The familial aromatase excess syndrome due to CYP19 mutation or chromosomal rearrangement is characterized by pre- or peripubeal onset of gynecomastia Drugs can cause gynecomastia by:- Acting directly as estrogenic substances (e.g., oral contraceptives, phytoestrogens, digitalis) Inhibiting androgen synthesis (e.g., ketoconazole) Action (e.g., spironolactone) Spermatocytic tumor also present as painless testicular mass but they mainly affects geriatric population without any hormone secretion