ABSTRACT
Klinefelter syndrome is a rare chromosomal disorder with at least one extra X chromosome in males resulting in male hypogonadism, androgen deficiency and impaired spermatogenesis. It is associated with an increased risk of certain malignancies; including leukemia, breast cancer, non-Hodgkin's lymphoma and mediastinal germ cell tumors, however, testicular tumors are rare in men with Klinefelter syndrome. Testicular epidermoid cysts are rare benign tumors affecting the testes. We report a case of bilateral testicular epidermoid cysts in a 30-year-old man known to have Klinefelter syndrome. He had an incidental finding of bilateral hard irregular-surfaced testes during routine assessment for testosterone replacement therapy. Biochemical investigation confirmed primary hypogonadism and ultrasound imaging demonstrated bilateral solid testicular masses with no blood flow seen within the lesions. The patient went on to have a right-sided radical orchiectomy with left-side sparing. The histology revealed features in keeping with that of a testicular epidermoid cyst with no evidence of malignancy. The patient was commenced on testosterone replacement therapy. This case emphasizes the importance of routine physical examination of the male external and internal genitalia when considering testosterone replacement therapy.
ABSTRACT
Acute adrenal hemorrhage (adrenal apoplexy) in the context of severe sepsis is potentially life-threatening. Diagnosis of this condition is difficult to achieve without a strong sense of suspicion. The concurrent use of anticoagulants increases the risk of adrenal hemorrhage in the context of sepsis. Abdominal CT imaging is helpful in detecting hemorrhage within the adrenal gland. Once the diagnosis is considered, prompt therapy with corticosteroids can improve recovery and survival. A follow-up scan to confirm the resolution of the hematoma is useful to ensure that there is no other cause of adrenal enlargement. We report a 76-year-old lady who was hospitalized because of unexplained anemia and abdominal pain and was discovered to have bilateral pneumonia and urinary tract infection with severe hypotension not responding to standard treatments. An abdominal CT scan confirmed the presence of bilateral adrenal hemorrhage. A subsequent finding of an inappropriately low serum cortisol level in the presence of physiological stress confirmed adrenal insufficiency. The patient's condition improved following corticosteroid replacement. A repeat CT scan performed 10 months following the patient's initial presentation demonstrated signs of resolution of the adrenal hematomas; however, the patient's adrenal function remained impaired.
