6 yo son non-obese pseudo gynecomastia ALL Clear no medical cause

[Audreyi]

GB,

Thanks a bunch I appreciate all of your input.  I am also confused over the pseudo v. real issue I mean really confused because from what I'm reading they say pseudo is only caused from obesity and "real" is caused by hormones.  I haven't found that much on early onset it makes me wonder if maybe it starts with adipose deposit and then the gland becomes more involved and enlarged over time.  It also makes me wonder about the doctor reviewing the radiology imagery and if perhaps they see mainly fat they call it pseudo versus mainly gland.  I have no idea but my sons pediatrician says if his blood tests come back normal we'll just monitor it and wait and see.  I'm still waiting on his blood results.  I'll update when I get them.

[Audreyi]

His labs came back within a fairly normal range.  His pediatrician wants him to be seen by an endocronologist so that's what we'll do.  All his blood was taken early in the morning and here are his levels.

Testosterone Total:      <0.10 L    ng/mL   reference range 1.75-7.81
Estrogen Total              16 (2)     pg/mL
ACTH, plasma               14          pg/mL   refrence range    6-48

[skyhawk]

Testosterone looks low up against the reference range, (if I am reading that correctly.)

[Audreyi]

Thats what I thought too it does indicate that it is out of range.  But who knows if they used the right reference or or if maybe it's normal for such a young kid.  I'll find out from the endocrinologist.  We are going to see a pediatric endo who's board certified.   

[skyhawk]

Your a great Mom. Wow!

Reference ranges on testosterone do vary greatly by age. If that reference range is correct for his age, his testosterone levels look very low.

I have to agree with one of the posts on this thread that it looks like early gynecomastia developing. At least thats my impression from the photo.

Androgens keep the chest flat, while estrogens cause mamamary glandular development and feminization of the breasts. Many doctors beleive its the ratio of Testosterone to Estradiol (E2) that causes gynecomastia to develop. I am clueless as to what a 6 year olds ratios should be. But I know who would know. A pediatric endocrinolgist.

I once met a guy and asked him what he did for a living. He surprised me when he told me he was a pediatric endocrinologist at The University of Texas Southwestern "Childrens" in Dallas. I never new such a specialty existed. I responded with "Kids have endocrine problems?" He said "Oh YES!"

BTW, did your son have any problems with an undescended testicle at birth? The majority of testosterone is produced in the testiscles, but he is so young this absolutely baffles me.

[Audreyi]

Skyhawk

Thanks for the info he has not shown any signs that would make me think his imbalance would be related to his testicles.  they seem fine but at his age nobody has actually checked them out.  I wonder if that is something the endo would do because I know his pediatrician has not.  I'm pretty sure he is doing just fine on "size" down there.  He is aggressive, asssertive, active, and fearless.  I have seen no signs of Femininity from him except for not being able to control his emotions be it anger or sadness.  From what I've read hormonal problems seem to be related to testicular or pituitary problems.  I'm still banking on his symptoms being idiopathic and resolving on their own.  It may not be realistic but that would be the greatest.  But if not at least I'm on it and having him checked out. 

[skyhawk]

Audrey, Yes, the pituitary gland sends  hormonal messages to the testicles. Lutinizing hormone (LH) tells the leydig cells in the testis to produce Testosterone. The pediatric endo will probably check LH and FSH ( folicle stimulating hormone) to see if its a pituitary problem.

There are other situations, like varicocele, but I have a hard time imagining  this at his age. Varicocele is where a valve in a vein fails and causes blood to pool up in the vein and raises the temperature of the testicles causing them to fail to produce adequate amounts of testosterone. This would cause future infertility problems if not corrected. But seriously, I doubt its varicocele at his age. Just another cause of low T.

Surely, if he does infact have low T, the endo will check for all these things. 

[Audreyi]

We saw the Endocrinologist and she thankfully didn't find and testicular tumors but she did order a number of tests to check everything out   She did tell me that half the time they never pinpoint a cause.  Which I found relieving because I'll take natural over there being something wrong any day.  Here's the tests she ordered:

HCG Quantitive
Hepatic Function
Prolactin
T4, Free
Testosterone, TOtal
TSH
Alpha Fetoprotein
LH
FSH
Estradiol

So it looks like I'm hitting his deductible this year!  Which is ok.  I'll post the follow up

[Grandpa Bambu]

Thanks for the update Audreyi...

GB

[Paa_Paw]

Well Mom, So far it sounds like you are doing all the right things.

Keep up the good work.

[johnnybot]

Its good that your informed and know whats going on. Now you child will deffinetly have better early years.

[Audreyi]

Good news!  No medical cause everything has checked out fine.  We'll just wait and see what happens through puberty and after, and of course if he has any further unusual growth I'll have him checked out again.  Thanks everybody

[Grandpa Bambu]

That's awesome news Audreyi...   

GB