Where are my testes?

摘要

In October, 2007, a 42-year-old man presented to us with pleuritic chest pain similar to his previous presentations of recurrent pulmonary emboli (PE). He was poorly compliant to warfarin prescribed for a diagnosis of heterozygous factor V Leiden deficiency 3 years previously. The most recent PE (July, 2006) was from self-cessation of warfarin a year ago for a period of 4 months. On examination he had bilateral painful gynaecomastia. On detailed questioning, he reported reduced libido and relationship problems which had evolved over the past year. Over the same period he also noted a continuous dull testicular ache, with gradual reduction in the size of his testes to the point that he could no longer feel them, painful gynaecomastia, erectile dysfunction, and reduced facial and body hair growth. He was an ex-military serviceman and had previously been well-built, but had noticed a gradual reduction in muscle bulk over a year. This constellation of symptoms had caused him much distress. There was no history of trauma. He was a non-smoker and did not drink alcohol. There was a history of clotting disorders in the family but he was unaware of the specific diagnoses.