Gynecomastia
Gynecomastia is the enlargement of the glandular tissue of the male breast, which can affect one or both breasts. This condition can arise from a variety of causes, including normal physiological changes during puberty, aging, endocrine disorders, and certain diseases like chronic liver or kidney disease. Additionally, it can be induced by a range of medications, including androgens, anabolic steroids, and some tranquilizers. Symptoms typically include breast enlargement, which may sometimes be accompanied by milk secretion, known as galactorrhea.
In newborns, gynecomastia may occur due to maternal hormones and generally resolves within a few weeks. During puberty, it is common for boys to experience this condition, often resolving within a year without any treatment. In adults, gynecomastia can sometimes indicate an underlying health issue, necessitating further investigation. Treatment varies based on the underlying cause, with many cases resolving naturally or requiring cessation of medication. In persistent or severe cases, surgical options may be considered, though they are not always completely satisfactory. Understanding gynecomastia is important for addressing both the physical and psychological impacts it may have on affected individuals.
Subject Terms
Gynecomastia
ANATOMY OR SYSTEM AFFECTED: Breasts, chest, endocrine system, glands
DEFINITION: An enlargement of the glandular part of the male breast that may affect one or both breasts.
CAUSES: Normal physiological changes, endocrine diseases, diseases such as chronic liver or kidney disease, tumors, certain drugs (androgens, anti-androgens, anabolic steroids, alcohol, cimetidine, diazepam, DES, digitalis, estrogens, some tranquilizers, schizophrenia drugs, marijuana, methadone, synthetic narcotics, growth hormone, tricyclic antidepressants)
SYMPTOMS: Enlargement of breasts in males, sometimes with milk secretion
DURATION: For normal causes, less than one year
TREATMENTS: None (self-resolving), cessation of drug use
Causes and Symptoms
True gynecomastia must be distinguished from malignant or benign breast tumors and from enlargement of the fatty part of the breast due to obesity. Causes of gynecomastia include normal changes with aging, endocrine diseases, other diseases such as chronic liver or kidney disease, tumors, and many drugs.
Some newborn boys may have swollen breasts as a result of the maternal to which they are exposed during pregnancy. This condition usually lasts for a few weeks following the newborn's birth. This enlargement may be accompanied by the secretion of milk, known as galactorrhea. Also, as boys go through puberty, up to 70 percent will experience gynecomastia, usually between the ages of twelve and fifteen. It is usually one-sided, but it may involve both breasts either at the same time or sequentially. This normally subsides within a year; the only treatment is reassurance that it will resolve on its own.
In athletes who take androgens and anabolic steroids, about half will develop gynecomastia. Other drugs that can cause this problem include alcohol, cimetidine, diazepam, diethylstilbestrol, digitalis, estrogens, some tranquilizers, many of the drugs used to treat schizophrenia, marijuana, methadone, synthetic narcotics, growth hormone, and tricyclic antidepressants.
Elderly men, particularly if they gain weight, may also develop gynecomastia because of the changes in the balance between male and female hormones that come with aging.
Types of cancer treatment leading to gynecomastia include drugs for lung, prostate, and testicular cancers. Likewise, tumors of the adrenal gland may cause this problem. Sometimes the enlargement of the breast tissue is the first sign of some serious underlying disease, but often it occurs for no apparent reason.
Men who develop gynecomastia where the cause is not obvious should have a radiographic study of the chest performed, along with blood studies to measure hormones such as prolactin, testosterone, luteinizing hormone, estradiol, and thyroid hormones. Some men may require genetic testing to determine the cause of their gynecomastia. Finally, a needle biopsy may be necessary.
Treatment and Therapy
The treatment of gynecomastia depends upon the cause. In the case of infant or pubertal boys, nothing is required but time for the problem to resolve on its own. When the condition is the result of a drug, it will usually resolve once the drug is stopped. Weight loss is indicated where the appearance of gynecomastia is attributable to obesity. Treating endocrine disorders, other illnesses, and tumors usually resolves the gynecomastia.
When the problem is painful, it may be treated with an antiestrogen drug. Severe or persistent gynecomastia may be treated by surgical means, although the results are not entirely satisfactory. In some cases, liposuction via the armpit and mastectomy performed under the skin may improve the situation.
Bibliography:
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