Case 1

My initial diagnosis is:Gynaecomastia with testicular tumor
Let us have a short discussion:
Enlargement of the male breast is known as gynaecomastia which happens due to wide varieties of causes. But the main pathology is an increased amount of estrogen (one of the two female hormones) over androgen in male which contributes to breast tissue development. Puberty is one of the physiological causes but that is not the case here although Richard is in pubertal age. Read more about gynaecomstia here: http://bit.ly/2zOjQHN

He has firm testicular mass which indicates testicular tumors. Seminomas and testicular teratoma are two commonly occurred tumors in the testis. Seminomas are rarely associated with raised hCG (human chorionic gonadotrophin hormone) but in 80% of cases of teratoma, hCG is positive. hCG has some estrogenic effect which contributes breast enlargement. Another point is, teratoma happens in earlier ages than seminomas. Read more about testicular tumors here: http://bit.ly/2zP5LJZ

So considering all the factors, my final diagnosis is
Gynaecomastia with testicular teratoma

Investigations:

• USG of the testes (scrotum)
• Urinary pregnancy test for Beta-hCG
• Blood tumor markers: Beta-hCG and AFP (alpha-fetoprotein)

Case 2

My diagnosis is acromegaly due to excess growth hormone(GH) due to GH producing tumor in pituitary gland. Simply, Pituitary tumor with acromegaly. The case has mentioned that Favor started having the problem when started menstruating but what happened later, hasn't told us. Beside enlarged leg size, if she is not having menstruation(amenorrhoea), then the chance of prolactin-secreting tumor known as prolactinoma of the pituitary gland also there. She is also having a visual problem which is due to the mass effect of pituitary tumor on the optic chiasma (optic chiasma is just situated above the pituitary gland).

Final diagnosis: Pituitary tumor (either GH producing tumor or prolactinoma or both) with mass effect with acromegaly

Investigation:

• Measurement of blood GH level
• OGTT (Oral glucose tolerance test)
• Measurement of IGF-1 (insulin-like growth factor-1)
• Pituitary MRI (MRI of the brain)
• Visual field test: Bitemporal hemianopia (Upper quadrant defect > lower quadrant defect= Pituitary tumor)