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Testicular tumour – gynaecomastia — RACP Paediatrics MCQ

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HardEndocrineTesticular tumour – gynaecomastiaRACP Paediatrics

A 16-year-old boy with gynaecomastia is found to have unilateral testicular enlargement (right testis 35 mL, left 15 mL). Beta-hCG is markedly elevated. Testosterone and oestradiol are elevated. Alpha-fetoprotein is normal. What is the most likely cause?

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Correct answer: B — Testicular tumour (hCG-secreting)

Unilateral testicular enlargement with elevated beta-hCG suggests an hCG-secreting testicular germ cell tumour (choriocarcinoma component). hCG stimulates testicular Leydig cells to produce testosterone, which is aromatised to oestradiol causing gynaecomastia. Urgent testicular ultrasound and oncology referral are required.

Reference: RACP Paediatric Curriculum – Endocrine/Oncology; RCH Melbourne – 2023