GYNAECOMASTIA

The presence of glandular breast tissue in males is called gynaecomastia . It results from an imbalance between estrogen and androgen. Estrogen promotes while androgen opposes breast tissue formation.

CAUSES OF GYNAECOMASTIA

Idiopathic

Physiological

Neonates

Peripubertal in adolescents

Old age

Drug-induced

■ Cimetidine

• Digoxin

• Spironolactone

• Anti-androgen therapies for prostatic carcinoma

• Some exogenous anabolic steroids,

Hypogonadism

Primary

Klinefelter’s syndrome

Autoimmune gonadal failure

Mumps orchitis

Haemochromatosis

Chemotherapy or infarction

Rare forms of congenital adrenal hyperplasia

Secondary

• Hypopituitarism

• Kallmann’s syndrome (GnRH deficiency)

• Hyperprolactinemia

Estrogen excess

Liver failure (impaired steroid metabolism)

An estrogen-secreting tumor (testes, adrenal)

Human chorionic gonadotrophin (HCG)-secreting tumors (testes, lung)

DIAGNOSIS

Take proper history especially drug history. Practically most of the patients with gynecomastia
are on drugs such as spironolactone for cardiac failure or cirrhosis of the liver.

Perform serum testosterone, FSH, LH, estradiol, prolactin, and HCG.

MANAGEMENT

Treat the cause

Surgical excision by a plastic surgeon for cosmetic reasons.