Development Of Gynecomastia Research Articles

Gynecomastia and Its Management In Boys With Partial Androgen Insensitivity Syndrome.

Partial androgen insensitivity syndrome (PAIS) is a rare condition that is reported to be commonly associated with gynecomastia in males. To assess the management of gynecomastia in male PAIS. Retrospective review of males with PAIS over the age of 10 years in the I-DSD registry. Of the 205 eligible cases, information was available for 57 from 13 centers. An androgen receptor gene variant was confirmed in 45 (79%) with a median age at first presentation of 1.0 year (range 0.1, 26.0). Of the 45 genetically confirmed cases, gynecomastia was present in 41 (91%) with a median age at the time of gynecomastia development of 13.5 years (11.0, 29.0). In the other 4 (9%) with no gynecomastia, the median age at last assessment was 15.7 years (10.6, 17.0). In 30 cases with information available, micropenis was present at the time of gynecomastia development in 23 (77%). Of the 35 with information available, 2 (6%) exhibited spontaneous resolution between the ages of 15 and 21 years and 25 (71%) had breast surgery at a median age of 15.7 years (14.0, 23.0). Of these 25, 9 (26%) had previously received medical therapy. The median clinician score of effectiveness for medical therapy was 3 (1, 8) compared to 10 (3, 10) for surgery (P < .0001). In 31 with information available, 13 (42%) had received psychology support. Gynecomastia is common in PAIS but not universal. Surgical management may be more effective than medical therapy, but there is a need for further standardized and systematic studies.

Male gynecomastia linked to antipsychotics: a case report

IntroductionGynecomastia refers to the abnormal development of breast tissue in males, often posing a concerning symptom. Often, gynecomastia is associated with multiple factors, including the use of various drugs, notably certain atypical antipsychotics. Gynecomastia is a significant side effect that affects the quality of life of male patients taking antipsychotic medications. Among these, risperidone and paliperidone have been identified as the most prone to causing gynecomastia, although aripiprazole has garnered attention for its superior profile in controlling prolactin and gynecomastia. The relationship between these drugs and the development of gynecomastia lies in their ability to elevate prolactin levels, a hormone that regulates reproductive function and is involved in milk production. Several studies have shown that prolactin levels are more commonly elevated with risperidone and paliperidone prescription, thus triggering gynecomastia.ObjectivesThe study aims to investigate the management of gynecomastia in male patients receiving antipsychotic medications.MethodsThis research employs a retrospective analysis of patient records to examine the association between specific antipsychotic drugs, prolactin levels, and the development of gynecomastia, while also evaluating the effectiveness of aripiprazole as an alternative treatment.ResultsWe present the case of a 21-year-old male with no prior medical history who initiated treatment with oral paliperidone and later switched to 100 mg of long-acting injectable paliperidone once monthly during his initial admission for psychotic symptoms. After six months, he developed gynecomastia, which was ruled out as breast tissue and was determined to be an increase in adipose tissue. Since his hospital discharge, he has gained 25 kg (30%) in body weight, and his baseline prolactin level has decreased. This weight gain, a common side effect of several antipsychotics, was linked to gynecomastia. However, a promising approach for gynecomastia antipsychotic-associated treatment is aripiprazole, which has a milder impact on prolactin levels. In this case, during the next appointment, a switch to 400 mg of long-acting injectable aripiprazole once-monthly was made, which led to weight loss, a reduction in breast size and blood prolactin levels in the following weeks.ConclusionsThe detection and management of gynecomastia in these patients are crucial to improving their quality of life and treatment adherence. This management encompasses changes in medication, hormonal therapy, or surgery in severe cases. Physicians must be aware of this potential complication when prescribing antipsychotics and closely monitor at-risk patients. In summary, antipsychotic-associated gynecomastia in men represents a medical challenge that requires careful attention and an individualized treatment strategy for each affected patient.Disclosure of InterestNone Declared

Prophylaxis for Treatment-Induced Gynecomastia in Prostate Cancer Patients: A Network Meta-Analysis.

Treatment-induced gynecomastia is a side-effect that can severely limit quality of life in prostate cancer patients. We performed a network meta-analysis (NMA) to comparing the effectiveness of multiple non-surgical prophylactic treatment for gynecomastia. A systematic review was performed through MEDLINE, Cochrane Central Register of Controlled Trials and meeting abstracts to identify randomized controlled trials comparing treatments for treatment-induced gynecomastia. Treatments included radiotherapy (RT), Anastrozole (ANZ), daily Tamoxifen (TMQD), and weekly Tamoxifen (TMQW), compared to no treatment/placebo (NoTx). The primary endpoint was events of gynecomastia development. Odds Ratio (OR) was the effect size of choice. An NMA was used to compare treatments with random-effects model was used. All tests were 2-sided with an alpha of 0.05. A total of 9 studies involving 1319 patients were identified with 5 distinct arms: RT (n = 358), ANZ (n = 90), TMQD (n = 321), TMQW (n = 39) and NoTx (n = 511). Gynecomastia occurred in 79.2% (405/511) of patients with NoTx, 65.5% (59/90) with ANZ, 37.7% (135/358) with RT, 19.6% (63/321) with TMQD and 74.4% (29/39) with TMQW. TMQD was significantly better than RT (OR 4.73 [1.53, 14.61]), ANZ (OR 7.21 [2.25,23.06]), TMQW (OR 6.25 [1.07, 36.43]) and NoTx (OR 26.30 [10.42,66.40]). RT were significantly better than NoTx (OR 5.56 [2.58,11.95]), but did not reach significance compared to ANZ (OR 1.52 [0.36, 6.43]) or TMQW (OR 1.32 [0.16, 10.70]). ANZ was significantly better than NoTx (OR 3.65 [1.03,12.93]). TMQW was not significantly better than NoTx. RT, TMQW and ANZ were significantly worse compared to TMQD in terms of preventing gynecomastia development. Daily Tamoxifen was the best prophylactic treatment choice, significantly better than RT, weekly Tamoxifen and Anastrozole. RT, weekly Tamoxifen and Anastrozole were significantly better than No Treatment/Placebo, but not daily Tamoxifen, in terms of prevention of treatment-induced gynecomastia in patients with prostate cancer.

The Burden of Anabolic Androgenic Steroid-Induced Gynecomastia.

Introduction Gynecomastia is benign proliferation of male breast tissue that can be idiopathic or secondary to hormonal imbalance. Consumption of steroids plays a major role in the development of gynecomastia. The increased consumption of anabolic androgenic steroid (AAS) in youngsters to boost the physical strength and improve appearance is associated with increased prevalence of gynecomastia. True estimation of AAS-associated gynecomastia is difficult to calculate and prone to underestimation because of low social acceptance. Accurate estimation is required to assess future healthcare, for prevention and to give appropriate treatment. Aims and Objectives The aim of this study was to calculate the steroid consumption in gynecomastia patients accurately so that appropriate treatment can be given and their response to treatment could be analysed. Methods This is a prospective study done in a tertiary care hospital from June 2019 to June 2022. All the gynecomastia patients treated during this period in Burns & Plastic Surgery Department of PGIMS Rohtak were included in the study. Patient's detailed history was recorded and also after 3 months of surgery patients were again enquired about their history to record any change. Results Real prevalence of AAS-associated gynecomastia (39.19%) was much higher than that recorded in preoperative period (4.05%). Also, AAS users were having higher body mass index and a greater proportion of patients were bodybuilders. Conclusion Patients with high body mass index, athletic body, and history of recent weight gain should raise the suspicion of anabolic steroid intake. Surgery is not always indicated in AAS-associated gynecomastia. If gynecomastia persisted, surgery necessitates and it involves meticulous intraoperative hemostasis and careful glandular excision to minimize recurrence and achieve low complication rates.

Gynecomastia: an uncommon, destabilizing condition of the male adolescent. our therapeutic choice.

Gynecomastia is the benign enlargement of breast's the glandular tissue in male population. Gynecomastia can involve fatty and/or glandular tissue. At the basis of pediatric gynecomastia there is a multifactorial imbalance in the ratio of estrogen to androgens tissue levels. In more than 95% of the cases gynecomastia development is idiopathic. Secondary causes of gynecomastia in adolescents are relatively rare (less than 5%) and may arise from uncommon pathological conditions. Gynecomastia is self-limited and regresses in 1-3 years in 84%, 47% and 20% of adolescents with mild, moderate and severe gynecomastia. The correct first line of therapy is observation and reassurance in the treatment of mild cases. In order to manage adolescent gynecomastia is advised to adopt a tailored therapy. Despite gynecomastia is a common condition only few adolescents need cosmetic or antalgic treatment. Medical therapy should be considered in patient with emotional distress or psychological limitation on normal activities. Finally, if gynecomastia does not go in remission after two years surgical procedures should be performed. The aim of this article is to be an updated discussion of pubertal gynecomastia in every way and report our surgical experience with a retrospective study. In conclusion surgical treatment of this condition is a quiet rare procedure but, in according to global literature we demonstrated that it is a safe surgery with low rate of complications.

Gynecomastia associated with methotrexate therapy for psoriatic arthritis

Methotrexate is widely used for treatment rheumatic diseases, including psoriatic arthritis. Adverse reactions could develop during methotrexate therapy, the most common of which are skin lesions, liver dysfunction, diarrhea, nausea, etc. Gynecomastia is a rare complication of low-dose methotrexate therapy. The mechanism of its development is not fully understood. We present a case report of the development of gynecomastia in a patient with psoriatic arthritis during treatment with methotrexate.

Association of adenovirus 36 and gynecomastia development: A case-control study

Association of adenovirus 36 and gynecomastia development: A case-control study

Rosuvastatin induced gynecomastia: a rare presentation of newer statin

Gynecomastia is a common benign disease characterized by the progressive enlargement of the glandular tissue of the male breast. The etiology may vary and may be physiological, pharmacological, pathological, or even idiopathic. Among men, drug induced gynecomastia may account for 10-20% of cases. Several case reports have associated this condition to the use of statins. However, there are few case reports of rosuvastatin induced gynecomastia have been reported in literature. We describe a 45-year-old male who developed bilateral gynecomastia after one month of rosuvastatin therapy, after switching to a different or less potent statin (atorvastatin), his symptoms resolved with-in one month. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship between the patient’s development of gynecomastia and rosuvastatin therapy.

Brexpiprazole-Induced Gynecomastia in a Thirteen-Year Old Male

This case reports involves a thirteen-year-old male with a history of anxiety, depression, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD) who developed significant weight gain and gynecomastia ten months after starting brexpiprazole. He had prior trials of quetiapine and aripiprazole which caused significant weight gain but did not cause gynecomastia. He had been taking sertraline and guanfacine for almost two years prior to starting brexpiprazole. Eight months later he was started on dexmethylphenidate for ADHD symptoms. There were no other recent exposures. After these symptoms developed, brexpiprazole and dexmethylphenidate were discontinued and several weeks later his gynecomastia resolved. Dexmethylphenidate is not known to cause gynecomastia. Although atypical antipsychotics have been known to cause gynecomastia, no case reports have identified brexpiprazole causing gynecomastia. Sertraline, a known cytochrome P450 2D6 inhibitor, is one of the primary metabolizers of brexpiprazole. We hypothesize that sertraline may have delayed the metabolism of brexpiprazole through inhibition of cytochrome P450 2D6 which led to elevated levels of brexpiprazole. This may have contributed to development of gynecomastia. This case report emphasizes the importance of closely monitoring drug-drug interactions as well as uncommon adverse effects of medications.

A Comparison between Both Mineralocorticoid Receptor Antagonist Agents (Eplerenone and Spironolactone) in Prognosis of Heart Failure with Reduced Ejection Fraction (HFrEF)

Background: heart is the target organ for Aldosterone, spironolactone and eplerenone (mineralocorticoid receptor antagonists) inhibits the aldosterone extraction through the heart in patients with congestive heart failure (CHF). Objective: to evaluate prognostic impact of both MRA (spironolactone and eplerenone) on heart failure and compare between both agents in incidence of side effect (gynecomastia and hyperkalemia). Patients and Methods: the study was conducted from March 2016 to September 2016 at Aswan University hospital. Our study population consisted of 100 adult patients, who were proved to have heart failure symptoms, with reduced ejection fraction heart failure divided in two groups. Group A contains 50 patients on spironolactone in addition to other anti-failure treatments according to ESC guidelines. Group B is 50 patients on eplerenone in addition to other anti-failure treatments according to ESC guidelines. Results: follow up had been done after one month for patient clinical status and serum potassium level and development of gynecomastia. Another Follow up was done after 3 months for BNP level, gynecomastia, NYHA classification and body weight. Conclusion: MRA are important line of treatment in HF patients, eplerenone and spironolactone are both have good result in improving BNP level and improving NYHA classifications and patients weight loss.

A Comparison between Both Mineralocorticoid Receptor Antagonist Agents (Eplerenone and Spironolactone) in Prognosis of Heart Failure with Reduced Ejection Fraction (HFrEF)

Background: heart is the target organ for Aldosterone, spironolactone and eplerenone (mineralocorticoid receptor antagonists) inhibits the aldosterone extraction through the heart in patients with congestive heart failure (CHF). Objective: to evaluate prognostic impact of both MRA (spironolactone and eplerenone) on heart failure and compare between both agents in incidence of side effect (gynecomastia and hyperkalemia). Patients and Methods: the study was conducted from March 2016 to September 2016 at Aswan University hospital. Our study population consisted of 100 adult patients, who were proved to have heart failure symptoms, with reduced ejection fraction heart failure divided in two groups. Group A contains 50 patients on spironolactone in addition to other anti-failure treatments according to ESC guidelines. Group B is 50 patients on eplerenone in addition to other anti-failure treatments according to ESC guidelines. Results: follow up had been done after one month for patient clinical status and serum potassium level and development of gynecomastia. Another Follow up was done after 3 months for BNP level, gynecomastia, NYHA classification and body weight. Conclusion: MRA are important line of treatment in HF patients, eplerenone and spironolactone are both have good result in improving BNP level and improving NYHA classifications and patients weight loss.

Anabolic-androgenic Steroid Use Among Gynecomastia Patients: Prevalence and Relevance to Surgical Management.

Anabolic-androgenic steroids (AAS) are widely implicated in gynecomastia development. Surgery is the definitive treatment for cases persisting after cessation of AAS use. Currently, the relevance of AAS use to the surgical approach of gynecomastia has not been well explored. This study aims to compare patient characteristics, surgical outcomes, and surgical management of gynecomastia correction in AAS users versus nonusers. A retrospective cohort study was performed with patients who underwent bilateral gynecomastia reduction surgery between January 2005 and August 2015 by a single surgeon at an academic hospital. Demographic data, AAS usage details, operative documentation, and follow-up outcomes were reviewed. A total of 964 cases were reviewed. Eleven percent (n = 105) of the patients had a history of AAS use. Compared with non-AAS users, AAS users were older at time of gynecomastia onset (15 years vs 13 years, P < 0.001) and surgery (28 years vs 25 years, P < 0.001). The AAS users had higher body mass index (27.3 kg/m vs 25.7 kg/m, P < 0.001) and a greater proportion of patients self-identified as bodybuilders (40.0% vs 22.4%, P = 0.002). Although no difference was found in the excised bilateral mastectomy volume (92.1 cm vs 76.4 cm, P = 0.20), The AAS users had significantly less lipoaspirate fat volume (250 mL vs 300 mL, P = 0.005). No difference was found in total complication rates. However, AAS users had significantly more revision mastectomy surgeries (3.8% vs 1.1%; P = 0.02). The unique breast composition of AAS users necessitates a surgical approach with meticulous intraoperative hemostasis and careful glandular excision to minimize recurrence and achieve comparable low complication rates.

Gynecomastia as paraneoplastic syndrome

Background. Gynecomastia is one of the most famous and common paraneoplastic syndromes. With the growth of equipment clinics with modern diagnostic equipment, including the CT, increases the detection of breast pathology in men. There is the need for a correct interpretation of the data about the state of male breast by radiologists, and the attending physician, oncologist, mammologist, urologist, endocrinologist.&#x0D; The purpose of the study to identify possible differences in frequency and radiation pattern of gynecomastia in patients with cancer and without it and also to follow the dynamics of the development of gynecomastia in patients with cancer, to identify the probable causes of the progression of gynecomastia in patients with cancer.&#x0D; Materials and methods. It's data of 400 chest CT of men who were screened and treated for the different oncological pathology in Voronezh regional clinical oncological hospital in 2013-2015. And also data of 150 chest CT of men who were screened and treated for the various diseases (excluding oncological diseases) in the Voronezh regional clinical diagnostic center and Kursk regional clinical hospital in 2013-2015 was used.&#x0D; Results. The data of the frequency of occurrence various types of gynecomastia in patients with cancer pathology and without it was obtained. The frequency of occurrence of gynecomastia in patients with cancer depending on the localization and morphology of tumor was analyzed. The dynamics of the gynecomastia in patients with cancer was tracked and possible causes of its progression in patients in this group were identified.&#x0D; Conclusions 1. Gynecomastia is a frequent pathology revealed by chest CT in men as suffering from oncological disease and without it.&#x0D; &#x0D; Gynecomastia significantly more often found in patients suffering from prostate adenocarcinoma and renal cell carcinoma.&#x0D; Surgical injury may be one of the reasons for the development of gynecomastia.&#x0D; Feature of gynecomastia in patients with cancer is its asymmetry. When the detection of asymmetrical gynecomastia by chest CT is recommend the further examination of patient to exclude him cancer pathology, special attention should be paid to the prostate gland and the kidneys.&#x0D; Upon detection of the progression of gynecomastia in a patient with a history of cancer need further examination to exclude cancer pathology progression.

Clinical, Cytogenetic, and Histopathologic Profile of a Case Of 46,XY Gonadal Dysgenesis

ABSTRACT Objective: This case report will highlight the importance of histopathologic analysis of the gonads to differentiate ovotesticular disorder of sexual development (OT-DSD) from mixed gonadal dysgenesis. Both disorders may have the same clinical and cytogenetic presentation, but the latter presents high risk for gonadal malignancy, hence there is usually a need for early gonadectomy, while the former has a low risk for malignancy. Therefore OT-DSD patients may have the opportunity for spontaneous pubertal development and fertility with regular tumor surveillance. Methods: We report the case of a 22-year-old patient reared as a male with a 46,XY karyotype diagnosed as OT-DSD by gonadal biopsy. The patient presented with microphallus with chordee, penoscrotal hypospadias, poor virilization, and development of gynecomastia at puberty. Results: Histopathologic examination of the single tubule biopsy of the left gonad showed seminiferous tubules lined by Sertoli cells and Leydig cells in the interstitia...

Acute Tissue Trauma as a Trigger for Gynecomastia Development and Progression

Over the last 50 years a great variety of etiologic factors for gynecomastia have been investigated and discussed. However, the possible role of the chronic and acute tissue trauma still remains unclear. The authors report on and discussed the possible role of a single episode of acute trauma as a trigger mechanism for the onset of breast enlargement.

Evaluation of Serum Vitamin D Levels in Adolescents with Pubertal Gynecomastia

Background: Since vitamin D has an inhibitory function on ductal morphogenesis of the pubertal mammary gland, it may have a role in the development of gynecomastia. The aim of this study was to determine the effect of vitamin D deficiency on the development of pubertal gynecomastia. Methods: Serum 25-hydroxyvitamin D (25D) levels in 50 adolescents with pubertal gynecomastia and 54 healthy controls between the ages of 11 and 17 years were compared. Results: Mean 25D level was 14.03 ± 6.38 (5.0-32.5) ng/ml in the pubertal gynecomastia group and 15.19 ± 6.49 (5.0-33.2) ng/ml in the control group (p = 0.361). According to the vitamin D status classification of the American Academy of Pediatrics, 66% of the pubertal gynecomastia group was found to be deficient and 14% were insufficient. In the control group these values were 53.7% and 29.6%, respectively (p = 0.158). Conclusion: From our results we hypothesize that, rather than low serum levels of 25D, a dysregulation of the vitamin D signal pathway, vitamin D metabolism or vitamin D storage within the mammary tissue might be the contributing factors to the development of gynecomastia.

Post-traumatic onset of secondary progression of gynecomastia

Gynecomastia is a benign enlargement of the male breast which can be a source of significant anxiety and embarrassment for the patients. A great variety of etiologic factors have been investigated and discussed. However, only few studies in the literature have accentuated on the possible role of the chronic tissue trauma for the de novo development of gynecomastia. Nevertheless, the exact mechanism of its onset in such cases remains unclear. The authors report on a case of posttraumatic unilateral progression of preexisting stable gynecomastia. The possible role of a single episode of acute trauma as a trigger mechanism for the new onset of the breast enlargement is discussed.

Methylphenidate induced gynecomastia in a prepubertal boy: a case report

Methylphenidate is a frequently used treatment choice in attention deficit hyperactivity disorder. In this paper we will present a prepubertal boy who suddenly developed bilateral gynecomastia after sustained release methylphenidate (OROS MPH) treatment and we will discuss literature on this topic. Although the mechanism is not known, rare development of gynecomastia should be kept in mind in cases using methylphenidate.

The role of Ad-36 as a risk factor in males with gynecomastia

Gynecomastia is highly prevalent worldwide and Adenovirus-36 (Ad-36), recently implicated in increased adipose tissue deposition due to its affinity for adipose tissue, is a potential etiological agent in the development of obesity and therefore we hypothesized that Ad-36 may also play a role in the development of gynecomastia by possibly accompanying increased regional adiposity.To support our hypothesis, we conducted a study that included 33 adult males with gynecomastia (PG) and 15 adult males as the patient control group (HCG). Leptin and adiponectin levels were monitored using ELISA. A significant difference in Ad-36 antibody positivity was found between the groups (p<0.05). Average leptin levels were found to be higher, but average adiponectin levels were found to be lower in Ad-36 Ab(+) patient group. No Ad-36 DNA was detected in any tissue samples.In conclusion, we hypothesize that low-grade chronic inflammation, which was caused by Ad-36 infection, possibly caused an increase in circulating leptin. This in turn may have caused an increase in local or circulating estrogens and/or the estrogen/androgen ratio by stimulating the aromatase enzyme activity in adipose stromal cells and breast tissues. We suggest that gynecomastia may develop following an increase in aromatase enzyme activity, by which more oestrogen is produced and the estrogen–androgen balance disrupted. Also, regional adipose tissue enlargements may cause the excessive production of estrogens leading to gynecomastia. Adipose tissue has been recognized as a major endocrine organ in recent years. Another plausible explanation is excessive aromatization of androgens to estrogens by peripheral adipose tissue may promote gynecomastia in males. Moreover, our results suggest that there might be a relationship between Ad-36 and gynecomastia.

Antidepressant-Selective Gynecomastia

To describe what we believe is the first reported case of synergistic gynecomastia during treatment of depressive and anxiety disorders when sertraline was added to a stable medication regimen including duloxetine, rosuvastatin, and amlodipine. A 67-year-old male with major depression, dysthymia, obsessive-compulsive disorder, social anxiety, hypertension, diabetes, and hyperlipidemia presented with new-onset gynecomastia and breast tenderness. Mammography revealed bilateral gynecomastia (fibroglandular tissue posterior to the nipples bilaterally) without suspicious mass, calcification, or other abnormalities. These new symptoms developed after sertraline was added to his stable medication regimen (duloxetine, alprazolam, rosuvastatin, metoprolol, amlodipine, hydrochlorothiazide/triamterene, metformin, and sitagliptin). These symptoms were dose-dependent, with gynecomastia and breast tenderness more severe as sertraline was titrated from 25 mg/day to 50 mg/day and then to 75 mg/day. When sertraline was discontinued, gynecomastia and breast tenderness rapidly resolved. Mammoplasia and gynecomastia are associated with altered dopamine neurotransmission and/or perturbations in sexual hormones. These adverse effects may be medication induced. Selective serotonin reuptake inhibitors (sertraline), serotonin-norepinephrine reuptake inhibitors (duloxetine), rosuvastatin, and amlodipine have been reported to cause these adverse effects. This case was unique, since the patient had been on both sertraline and duloxetine previously as independent psychotropics without the development of gynecomastia. In the context of an additive drug adverse effect, the probability of sertraline as the precipitant drug was determined by both the Naranjo probability scale and the Horn drug interaction probability scale as probable. Gynecomastia is associated with antidepressants and other medications but is rarely addressed. Gynecomastia may be antidepressant selective or may be the result of additive adverse effects. Clinicians are advised to question patients regarding this potential adverse effect. Further education of clinicians is indicated.