Gynecomastia (American
English) or Gynaecomastia (English) is the growth of abnormally big
breasts on men. It comes from the Greek word Gyne meaning "lady" and Mastos
meaning "breast". The condition can occur physiologically in adolescents, in
neonates, and in older men. In many adolescent boys the symptoms disappear
within a couple years at most. It is usually just a result of an imbalanced
hormones, although there can be many different causes.
Causes of Gynecomastia
Physiologic gynecomastia occurs in neonates, with aging and in puberty.
Potential pathologic causes of gynecomastia are: increased serum estrogen,
androgen receptor defects, medications including hormones, decreased
testosterone production, chronic kidney disease, HIV, chronic liver disease,
and other chronic illness. Gynecomastia as a result of spinal cord injury and
refeeding after starvation has been reported. In a quarter of all cases
the cause is unknown.
Medications cause over 15% of cases of gynecomastia. These include
spironolactone, cimetidine, finasteride, omeprazole and some antipsychotics.
They can act directly on the breast tissues, while some lead to increased
secretion of prolactin from the pituitary by blocking the actions of dopamine (PIF/Prolactin-Inhibiting
Factor) on the lactotrope cell groups in that organ. Androstenedione, used as a
performance enhancing food supplement, can lead to breast enlargement by excess
estrogen activity. Marijuana usage is thought to be another possible cause.
Increased estrogen levels can also occur with certain testicular tumors, and in
hyperthyroidism. Certain adrenal tumors cause elevated levels of androstenedione
which is converted by the enzyme aromatase into estrone, a type of estrogen.
Other tumors that secrete hCG can increase estrogen. A decrease in estrogen
clearance can occur in liver disease, and this could be the mechanism of
gynecomastia with liver cirrhosis. Obesity can also increase estrogen levels.
Decreased testosterone production can occur with congenital or acquired
testicular failure, for example in genetic disorders like Klinefelter Syndrome.
Diseases of the pituitary or hypothalamus can also lead to low testosterone.
Abuse of anabolic steroids has a similar effect.
Diagnosis of Gynecomastia
This condition can usually be diagnosed by a physician. Occasionally, imaging
by ultrasound or X-rays is needed to confirm diagnosis. Blood tests are required
to check if there is any underlying disease causing the gynecomastia.
Prognosis of Gynecomastia
Gynecomastia is not physically harmful, but in a few cases it is an indicator of
more dangerous underlying conditions. Gynecomastia presents social and
psychological difficulties for the sufferer. Weight loss ,ay alter the condition
in cases where it is triggered by obesity, but for many it will not eliminate it
as the breast tissue remains.
Gynecomastia Treatment
Treating the underlying cause of the gynecomastia may lead to improvement in the
condition. Patients should stop taking medications which can cause gynecomastia.
Anti-estrogen medications, such as clomiphene and tamoxifen or androgens can be
used. Aromatase inhibitors are another treatment option, although they are not
universally approved for the treatment of gynecomastia. Endocrinological
attention may help during the first 2-3 years. After that window, however, the
breast tissue tends to remain and harden, leaving surgery (either liposuction or
reduction mammoplasty) the only treatment option until Gynexin. Some men choose
to live with the condition and wear a bra for support.
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