Gynecomastia Research Articles

Adolescent gynecomastia is associated with a high incidence of obesity, dysglycemia, and family background of diabetes mellitus.

Background:Gynecomastia during adolescence is common though etiology is not clear. We studied the clinical and hormonal profile of adolescent patients with gynecomastia.Methodology:Patients who had onset of breast development between age 10 and 20 years were included in this study. Their clinical profile, biochemical, and hormonal parameters were studied.Results:Of 94 patients with gynecomastia, 4 had hypogonadotropic hypogonadism, 4 had hypergonadotropic hypogonadism, and 1 had fibroadenosis, but in majority (90.4%), no apparent cause for breast enlargement was evident. In the idiopathic group, majority were obese (63%). Fourteen (16%) patients had impaired fasting glucose or impaired glucose tolerance. Another twenty patients had subtle abnormalities (high 1 h glucose or glucose peak at 2 h). Twenty-nine percent of lean and 38% of obese patients had mild abnormalities in glucose profile. Sixty percent of patients had family background of diabetes. Obese patients had lower testosterone as compared to lean patients; however, estradiol, luteinizing hormone, and follicle-stimulating hormone levels were similar in the two groups.Conclusion:Gynecomastia during adolescence is associated with obesity, dysglycemia, and family background of diabetes mellitus.

Ductal carcinoma in situ in a 35-year-old male presenting with ipslateral gynecomastia

Concomitant ductal carcinoma in situ (DCIS) and ipslateral gynecomastia (GM) are very rarely reported in male

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.

A case with secondary amenorrhoea with hyperandrogenism

We presented a case with complete androgen insensitivity syndrome. The patient had secondary amenorrhea. Physical examination found ambiguous external genitalia, bilateral gynecomastia, no axillary hair or pubic hair. Lab workup found hyperandrogenism and 46XY karyotype. Ultrasound failed to find uterus but hypoecho on both sides of pelvic cavity. A homozygous missense mutation of T572C in exon 2 of androgen receptor gene was identified in this patient. (Chin J Endocrinol Metab, 2016, 32: 781-783) Key words: Androgen insensitivity syndrome; Male pseudohermaphroditism; Androgen receptor gene mutation

The profile of tamoxifen user due to gynecomastia induced by anabolic steroids for bodybuilders or bodybuilding

Due to valorization of body appearance, the seek for a good physic body gets a central importance in externalization of subjectivity and in the construction the identities of the people. Because of this, them invest time to look for devices to streamline results to get a perfect body, between mechanisms used there is the use of anabolic steroids (AS). With the rapid response this kind of treatment, there are aware concerns their side effects such as gynecomastia which is characterized by breast enlargement of man. In an attempt to prevent this effect aesthetically uncomfortable, the users seek take medicines such as tamoxifen to reverse or prevent this situation without proper prescription or monitoring of a pharmacist professional, as well as almost all treatments with EA which are made clandestinely. This work aimed to describe profile among consumers seeking the tamoxifen therapy to prevent or treat gynecomastia induced using EA. The target audience was composed of bodybuilders men that were making anabolic cycles, aiming fast muscular hypertrophy. Two questionnaires were applied, one to the drugstores that sell these drugs and one for bodybuilders who buy these drugs. Tamoxifen user profile found in this study shows that they are young people aged 18 to 35 years old, seeking muscle hypertrophy strength. As the natural results are slow, influenced by training friends, start using EA, even declaring know about the risks to health. Use along with these steroids, tamoxifen, in an attempt to prevent or treat gynecomastia, get the medication in drugstores without a prescription and without the pharmacist questioning, demonstrating that pharmaceutical care is still not fully deployed and functioning.

Medsafe reports cases of drug-induced gynaecomastia

Medsafe reports cases of drug-induced gynaecomastia

Inherited Xq13.2-q21.31 duplication in a boy with recurrent seizures and pubertal gynecomastia: Clinical, chromosomal and aCGH characterization

We report on a 16-year-old boy with a maternally inherited ~18.3 Mb Xq13.2-q21.31 duplication delimited by aCGH. As previously described in patients with similar duplications, his clinical features included intellectual disability, developmental delay, speech delay, generalized hypotonia, infantile feeding difficulties, self-injurious behavior, short stature and endocrine problems. As additional findings, he presented recurrent seizures and pubertal gynecomastia. His mother was phenotypically normal and had completely skewed inactivation of the duplicated X chromosome, as most female carriers of such duplications. Five previously reported patients with partial Xq duplications presented duplication breakpoints similar to those of our patient. One of them, a fetus with multiple congenital abnormalities, had the same cytogenetic duplication breakpoint. Three of the reported patients shared many features with our proband but the other had some clinical features of the Prader-Willi syndrome. It was suggested that ATRX overexpression could be involved in the major clinical features of patients with partial Xq duplications. We propose that this gene could also be involved with the obesity of the patient with the Prader-Willi-like phenotype. Additionally, we suggest that the PCDH11X gene could be a candidate for our patient's recurrent seizures. In males, the Xq13-q21 duplication should be considered in the differential diagnosis of Prader-Willi syndrome, as previously suggested, and neuromuscular diseases, particularly mitochondriopathies.

Pubertal Development

Pubertal Development

AKT question relating to gynaecomastia

AKT question relating to gynaecomastia

Endocrine and molecular investigations in a cohort of 25 adolescent males with prominent/persistent pubertal gynecomastia.

Pubertal gynecomastia is a common condition observed in up to 65% of adolescent males. It is usually idiopathic and tends to regress within 1-2 years. In this descriptive cross-sectional study, we investigated 25 adolescent males with prominent (>B3) and/or persistent (>2 years) pubertal gynecomastia (P/PPG) to determine whether a hormonal/genetic defect might underline this condition. Endocrine investigation revealed the absence of hormonal disturbance for 18 boys (72%). Three patients presented Klinefelter syndrome and three a partial androgen insensitivity syndrome (PAIS) as a result of p.Ala646Asp and p.Ala45Gly mutations of the androgen receptor gene. The last patient showed a 17α-hydroxylase/17,20-lyase deficiency as a result of a compound heterozygous mutation of the CYP17A1 gene leading to p.Pro35Thr(P35T) and p.Arg239Stop(R239X) in the P450c17 protein. Enzymatic activity was analyzed: the mutant protein bearing the premature stop codon R239X showed a complete loss of 17α-hydroxylase and 17,20-lyase activity. The mutant P35T seemed to retain 15-20% of 17α-hydroxylase and about 8-10% of 17,20-lyase activity. This work demonstrates that P/PPG had an endocrine/genetic cause in 28% of our cases. PAIS may be expressed only by isolated gynecomastia as well as by 17α-hydroxylase/17,20-lyase deficiency. Isolated P/PPG is not always a 'physiological' condition and should thus be investigated through adequate endocrine and genetic investigations, even though larger studies are needed to better determine the real prevalence of genetic defects in such patients.

男性乳腺发育症的研究进展

男性乳房发育症(gynecomastia, GYN)，又称男性乳腺增生症或男性乳腺肥大症。GYN在男性乳房疾病的发生率为32%~65%之间，15~40岁GYN发生率约为65%。其中约有一半或一半以上的GYN找不到明确的原因，在临床上通常将这种情况诊断为特发性GYN。 Gynecomastia (GYN) is known as the mammary gland hyperplasia and mammary hypertrophy of men. The incidence of GYN in male is between 32% - 65%, and in males aged 15 - 40, the incidence is about 65%. Among them, a half or more than a half of patients with GYN cannot find a clear rea-son, typically this will be the case on a clinical diagnosis of idiopathic GYN.

Association between plasma kisspeptin levels and adolescent gynecomastia.

Gynecomastia is defined as benign proliferation of male breast glandular tissue. To date, the pathophysiology of adolescent gynecomastia (AG) remains unclear. Kisspeptin is a polypeptide that plays an important role in the regulation of the hypothalamic-pituitary-gonadal hormonal axis. In this study, we investigated whether there is a relationship between kisspeptin and AG. This study included 40 males between 9 and 18 years of age diagnosed with gynecomastia. The control group consisted of 30 young healthy males in the same age range. The participants were evaluated with respect to anthropometric measurements (age, height, body weight, body mass index, breast and pubic stages and testicular volume). The levels of kisspeptin, follicle-stimulating hormone, luteinizing hormone, estradiol (E2), testosterone (T), and ratio of E2 to T were measured in both groups. The mean age was 13.8 years. There were no differences between the groups in terms of anthropometric parameters, plasma gonadotropin levels, estrogen levels, and E2/T (P > 0.05). Plasma kisspeptin (0.77 and 0.54 ng/mL, P < 0.05) and T (253.9 ng/dL and 117.9 ng/dL) levels were significantly higher in the AG group than in the control group (P < 0.001). Kisspeptin levels are an important factor in AG.

Study on serum hormones and liver function in male patients with liver cirrhosis and gynecomastia

Objective To investigate the relationship between the mechanism of gynecomastia and serum hormone levels, as well as liver function in male patients with liver cirrhosis. Methods Forty-six male patients with liver cirrhosis and gynecomastia were collected as gynecomastia group from March 2013 to March 2014, and at the same period seventy male patients with liver cirrhosis but without gynecomastia were studied as non-gynecomastia group. The condition of mammogenesis and maximum of breast thickness were measured by bilateral breast ultrasound. Hormones including luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), estradiol (E2), progesterone (PRGE), and testosterone (T); liver function including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and serum albumin (Alb); blood coagulation function including prothrombin time (PT), platelet count (PLT) were examined and the Child-Pugh scores were calculated. t-test was performed for results comparison between gynecomastia group and non-gynecomastia groups. Chi-square test was used to compare the difference in drinking rate between two groups. The patients of gynecomastia group and non-gynecomastia group were further divided into Child-Pugh Grade A, B and C subgroups according to Child-Pugh scores and the patients of gynecomastia group were divided into subgroups according etiology such as posthepatitic cirrhosis, alcoholic liver cirrhosis and posthepatitic cirrhosis combined with alcoholc cirrhosis. Single factor analysis of variance was applied to compare the laboratory findings between subgroups, and least-significant difference mothod was used to further compared the differences between two subgroups. Results Among forty-six male patients with liver cirrhosis and gynecomastia, the mean thickness of breast was (7.56±2.84) mm.All the differences of TBil, Alb, PT and Child-Pugh score of Child-Pugh grade patient were statistically significant between gynecomastia group and no gynecomastia group ((96.72±75.86) μmol /L vs (60.57±54.00) μmol /L, (29.12±4.90) g/L vs (33.86±6.86) g/L, (19.06±4.76) s vs (15.54±2.57) s, 11.54±0.91 vs 10.33±0.57, respectively, t=2.79, -4.33, 4.58, 2.22, all P 0.05). PRL and E2/T ratio ((404.49±297.26) mU/L and 68.74±46.37) were higher than those of non-gynecomastia group ((279.77±111.57) mU/L and 13.60±11.55), and T was lower than that of non-gynecomastia group ((7.15±5.74) nmol/L vs (15.46±8.53) nmol/L), and the differences were statistically significant (t=2.72, 7.90、-6.27; all P 0.05). T level of gynecomastia group gradually decreased, and those of Child-Pugh B, C subgroup ((8.20±7.58) nmol/L and (4.18±3.76) nmol/L) were siginificantly lower than that of Child-Pugh A subgroup of non-gynecomastia group ((17.64±9.04) nmol/L, F=9.37, P<0.05). The E2/T levels of gynecomastic group gradually increased. There was significant difference in E2/T level between Child-Pugh C subgroup of gynecomastia group (105.49±94.42) and Child-Pugh A grade subgroup of non-gynecomastia group (11.38±9.60, F=12.57, P<0.05). Conclusions There are different degrees of sex hormone disorder in the serum of male patients with liver cirrhosis and gynecomastia which is more significant in PRL, T and E2/T.T and E2/T level are correlated with the degree of liver functional impairment.Gynecomastia in alcoholic liver cirrhosis is more severe than that of posthepatitic liver cirrhosis. Key words: Liver cirrhosis; Gynecomastia; Sex hormones; Ultrasonography, mammary

Plasma Kisspeptin Levels in Newborn Infants with Breast Enlargement.

Objective: Kisspeptin levels have been reported in children with premature thelarche, precocious puberty and adolescent gynecomastia, but there are no reports on kisspeptin levels in the neonatal period. This study aimed to investigate plasma kisspeptin hormone levels in newborns with and without breast enlargement.Methods:Plasma kisspeptin levels and other related biochemical variables were investigated in this prospective study conducted on 40 (20 girls and 20 boys) newborn infants with breast enlargement and on 40 healthy control infants (20 girls and 20 boys). Two-milliliter venous blood samples were taken in hemogram tubes with K2EDTA. Kisspeptin assays were performed using the enzyme-immunoassay method.Results:Mean plasma kisspeptin levels were 0.6±0.2 ng/mL in the study group and 0.5±0.2 ng/mL in the control group. Plasma kisspeptin concentrations were significantly higher in the study group (p=0.039) and also showed a correlation with serum prolactin levels (p=0.006). Significant correlations were also determined between plasma kisspeptin and luteinizing hormone concentrations (p=0.05, r=0.312).Conclusion:The findings of this study suggest that plasma kisspeptin and serum prolactin levels may be involved in the physiopathology of breast enlargement in newborns.

The effect of tamoxifen on pubertal bone development in adolescents with pubertal gynecomastia

During puberty, estrogen has a biphasic effect on epiphyses; at low levels, it leads to an increase in height and bone mass, whereas at high levels, it leads to closure of the epiphysis. Tamoxifen is a selective estrogen receptor modulator that has been used in the treatment of pubertal gynecomastia. Although it has not been approved for this indication, studies have shown it to be both successful and safe. In males, the peak of pubertal bone development occurs during Tanner stage 3-4, which is also when pubertal gynecomastia reaches its highest prevalence. Thus tamoxifen treatment could potentially effect pubertal bone development. The aim of this study was to assess the effects of tamoxifen on bone mineral density (BMD) and skeletal maturation when used for pubertal gynecomastia. We evaluated 20 boys with pubertal gynecomastia receiving tamoxifen for at least 4 months. BMD was measured with dual-energy X-ray absorptiometry. Z-score and absolute BMD (g/cm(2)) was determined at baseline and 2 months after completing tamoxifen treatment. Bone age and height was evaluated before treatment and again one year later. Using absolute BMD (g/cm(2)), the mean difference from baseline was significant between the two groups both at spine (p=0.002) and femur (p=0.001), but not with the Z-score. This result was attributed to the expected increase during puberty according to sex and age. No significant effect on skeletal maturation was found (p=1.112). We conclude that when pubertal bone development is concerned, tamoxifen is safe for the treatment of pubertal gynecomastia as neither bone mineralization nor growth potential was affected.

A systematic review of literature on psychosocial aspects of gynecomastia in adolescents and young men

Gynecomastia represents a serious psychosocial challenge for many adolescent and young adult males, but short of surgery, little attention has been given to this concern. The purpose of this paper is to report findings from a systematic review of the literature about psychosocial correlates, psychosocial interventions, and quality of research evidence about young males with gynecomastia. From an initial 233 published papers, 10 studies were identified and reviewed. Five were descriptive case studies and included no statistical analyses. The other studies were all conducted with small samples. Despite the limited evidence, findings suggest that many young men suffer emotional distress concerning gynecomastia, but this distress has received few interventions beyond surgical removal of the breast tissue. Future studies are needed to address this problem more fully so that more aggressive measures such as frequent assessments of the physical and psychosocial aspects of the condition can be done by healthcare professionals.

Ovotesticular Disorder of Sex Development: A Single-Center Experience

Ovotesticular disorder of sex development (OT DSD) is a rare disorder of sex development characterized by the presence in the same individual of both histologically proven testis and ovary. There are scant data from the Indian subcontinent regarding this disorder. The aim of this study was to describe the clinical, biochemical, imaging, cytogenetic, surgical, and histopathologic findings and outcomes of patients with OT DSD from Western India. The records of patients referred to our center for disorders of sex development between 2005 and 2013 were reviewed, and 7 patients were found to have histologically proven OT DSD. The median age at presentation was 8 years (range, 2 months to 25 years). Clinical presentation varied from genital ambiguity and inguinal swelling at birth to gynecomastia and cyclical hematuria after puberty. Karyotype was 46, XX in 6 patients and 46, XY in 1 patient. All patients underwent pelvic ultrasonography, laparoscopy, and surgery for removal of gonads not congruous with the chosen sex of rearing. Gender assignment for all the patients was done by the parents at birth, which was mainly influenced by the external genitalia and sociocultural influences, with 5 out of the 7 patients being reared as males. There was no evidence of gonadal tumors in our study. OT DSD should be considered as one of the differential diagnoses in cases of ambiguous genitalia with nonpalpable or asymmetrical gonads, pubertal gynecomastia, and cyclical hematuria, irrespective of the karyotype or internal genitalia.

Diagnostic value of ultrasonography in gynecomastia

Objective To summarize and analyze characteristics and diagnostic value of ultrasonography in the diagnosis of 46 cases of gynecomastia sonographic image. Methods 46 cases of male breast lumps were tested by high frequency ultrasound probe The mammary glands position, thickness, border, shape, internal echo, the internal flow signals, with or without axillary lymph nodes were observed. Results There were 32 cases of unilateral disease, including 18 cases of left side,14 cases of right side,14 cases of bilateral disease. Sonographic indicated 28 cases of mammary gland tissue echo to see beneath the nipple with low echo, the boundary more clearly, more uniform internal echo; and 12 cases showed glandular tissue thickening, echogenic and showed cord-like,similar to the female gland hyperplasia sonogram;and 6 cases showed patchy irregularly echogenic area. Color Doppler performance was that the 33 cases showed glandular tissue without significant blood flow signals,10 cases showing 1-2 strip-shaped blood flow to see in the glandular tissue,3 cases showing more abundant flow signals. Conclusion Ultrasonography has no pain, with higher diagnostic yield reproducible operation, so gynecomastia is the preferred method. Key words: Gynecomasta; Ultrasonography

A 46,XX Male Adolescent Presenting with a Chief Complaint of Gynecomastia

Gynecomastia is a common condition characterized by the benign excessive development of breast tissue in boys and men. The condition is caused by excessive estrogen production that induces an increase in the estrogen-toandrogen ratio. 46,XX male syndrome is a rare disease characterized by male phenotype expression in an individual with XX sex chromosomes and no Y chromosome. The presence, absence, or mutation of the SRY gene can result in a diverse set of phenotypic expressions. The condition is typically diagnosed in late adolescence or adulthood, as it manifests in infertility and/or small testicular size. It is particularly difficult to differentiate pathological from physiological gynecomastia in adolescents. Here, we report the case of a 17-year-old boy with the 46,XX male syndrome who presented to our hospital with gynecomastia.

Surgical Strategies in the Treatment of Gynecomastia Grade I-II: The Combination of Liposuction and Subcutaneous Mastectomy Provides Excellent Patient Outcome and Satisfaction

Background: Gynecomastia (GM) is a benign condition with glandular tissue enlargement of the male breast. GM is classified into 4 grades of increasing severity. We describe a series of GM grade I-II, diagnosed, treated surgically and analyzed regarding feasibility, complication rate, and satisfaction. Methods: From 2005 to 2012, a chart review was performed for 53 patients. Preoperative examination included endocrine and urological examination and exclusion of other pathological conditions. The surgical technique consisted of liposuction through an inframammarian-fold incision and excision of the glandular tissue by a minimal periareolar approach. Results: A total number of 53 male patients with 104 breasts were available for analysis. By liposuction, a median of 300 ml (range: 10-1000 ml) was aspirated from each breast and 25.1 g (range: 3-233 g) gland tissue was resected. Surgery lasted between 25 and 164 min per patient (median: 72 min). 2 postoperative hemorrhages occurred (n = 2, 3.8%). 2 patients underwent re-operation due to cosmetic reasons (n = 2, 3.8%). Conclusions: This analysis demonstrates that treatment of GM grade I-II can easily be performed by liposuction combined with subcutaneous resection of the glandular tissue as a minimally invasive and low-impact surgical treatment with a low rate of complications and excellent patient satisfaction. Preoperative workup is important to rule out specific diseases or malignancy causing the GM.