Gynecomastia
2434756
225145143
2008-07-12T03:13:30Z
24.79.236.131
/* Causes */
{{DiseaseDisorder infobox
| Name = {{PAGENAME}}
| Image = Gynecomastia_001.jpg
| Caption = An obese teenage male with Gynecomastia.
| DiseasesDB = 19601
| ICD10 = {{ICD10|N|62||n|60}}
| ICD9 = {{ICD9|611.1}}
| OMIM =
| MedlinePlus = 003165
| eMedicineSubj = med
| eMedicineTopic = 934
}}
'''Gynecomastia''', or '''gynaecomastia''', {{pronEng|ˌgaɪnəkoʊˈmæstiə}} is the development of abnormally large [[mammary gland]]s in [[males]] resulting in breast enlargement, which can sometimes cause secretion of milk. The term comes from the [[Greek language|Greek]] ''gyne'' (oblique stem ''gynaik-'') meaning "woman" and ''mastos'' meaning "breast". The condition can occur physiologically in [[neonate]]s (due to female hormones from the mother), in [[adolescence]], and in the elderly. In adolescent boys the condition is often a source of distress, but for the large majority of boys whose pubertal gynecomastia is not due to [[obesity]], the breast development shrinks or disappears within a couple of years <ref>[http://www.keepkidshealthy.com/adolescent/adolescentproblems/gynecomastia.html Adolescent gynecomastia]</ref>. The causes of common gynecomastia remain uncertain, although it has generally been attributed to an imbalance of [[sex hormone]]s or the tissue responsiveness to them; a root cause is rarely determined for individual cases. Breast prominence can result from [[Organ hypertrophy|hypertrophy]] of breast tissue, chest [[adipose tissue]] and skin, and is typically a combination. Breast prominence due solely to excessive adipose is often termed ''pseudogynecomastia''<ref>{{cite journal| last=Braunstein| first=GD| title=Gynecomastia| journal=N Engl J Med| year=1993| month=Feb 18| volume=328| issue=7| pages=490–5| pmid=8421478| doi=10.1056/NEJM199302183280708}}</ref> or sometimes ''lipomastia''<ref>{{cite web
| last = Allee
| first = Mark R
| title = Gynecomastia
| publisher = WebMD, Inc. (emedicine.com)
| date = 2006-11-15
| url = http://www.emedicine.com/med/topic934.htm
| accessdate = 2007-05-20 }}</ref>.
Gynecomastia should be distinguished from [[work hypertrophy]] of the [[pectoralis]] muscles caused by much exercise, e.g. [[swimming]].
==Causes==
Physiologic gynecomastia (also called Turcios Disease) occurs in neonates, at or before [[puberty]] and with [[Senescence|aging]]. Many cases of gynecomastia are [[idiopathic]], meaning they have no clear cause.
Potential pathologic causes of gynecomastia are: medications including hormones, increased serum [[estrogen]], decreased [[testosterone]] production, [[androgen]] receptor defects, chronic kidney disease, chronic liver disease, [[HIV]] treatment,<ref>{{cite journal| last=Peyriere| first=H| coauthors=et al| title=Report of gynecomastia in five male patients during antiretroviral therapy for HIV infection| journal=AIDS| year=1999| month=Oct 22| volume=13| issue=15| pages=2167–9| pmid=10546872| doi=10.1097/00002030-199910220-00022}}</ref> and other chronic illness. Gynecomastia as a result of spinal cord injury and refeeding after starvation has been reported.<ref>{{cite journal| last=Heruti| first=RJ| coauthors=et al| title=Gynecomastia following spinal cord disorder|journal=Arch Phys Med Rehabil| year=1997| month=May |volume=78| issue=5| pages=534–7| pmid=9161376| doi=10.1016/S0003-9993(97)90171-4}}</ref> In 25% of cases, the cause of the gynecomastia is not known.
Medications cause 10-20% of cases of gynecomastia in post-adolescent adults. These include [[cimetidine]], [[omeprazole]], [[spironolactone]], [[imatinib|imatinib mesylate]], [[finasteride]] and certain [[antipsychotic]]s. Some act directly on the breast tissue, while others lead to increased secretion of [[prolactin]] from the [[pituitary]] by blocking the actions of [[dopamine]] (prolactin-inhibiting factor/PIF) on the [[lactotrope]] cell groups in the [[anterior pituitary]]. [[Androstenedione]], used as a performance enhancing food supplement, can lead to breast enlargement by excess [[estrogen]] activity. Medications used in the treatment of [[prostate cancer]] such as [[antiandrogens]] and [[Gonadotropin-releasing hormone analog|GnRH analogs]] can also cause gynecomastia. [[Marijuana]] use is also thought by some to be a possible cause; however, published data is contradictory.<ref>{{cite journal |author=Thompson D, Carter J |title=Drug-induced gynecomastia |journal=Pharmacotherapy |volume=13 |issue=1 |pages=37–45 |year= |pmid=8094898}}</ref>
Increased estrogen levels can also occur in certain testicular [[tumors]], and in [[hyperthyroidism]]. Certain adrenal tumors cause elevated levels of [[androstenedione]] which is converted by the [[enzyme]] [[aromatase]] into [[estrone]], a form of estrogen. Other tumors that secrete [[Human chorionic gonadotropin|hCG]] can increase estrogen. A decrease in estrogen clearance can occur in liver disease, and this may be the mechanism of gynecomastia in liver [[cirrhosis]]. [[Obesity]] tends to increase estrogen levels.<ref>{{cite journal| last=Glass |first=AR| title=Gynecomastia| journal=Endocrinol Metab Clin North Am| year=1994| month=Dec| volume=23| issue=4| pages=825–37| pmid=7705322}}</ref><ref>{{cite journal| last=Braunstein| first=GD| title=Aromatase and Gynecomastia| journal=Endocr Relat Cancer| year=1999| month= Jun| volume=6| issue=2| pages=315–24| pmid=10731125| doi=10.1677/erc.0.0060315}}</ref>
Decreased [[testosterone]] production can occur in congenital or acquired testicular failure, for example in [[genetic disorder]]s such as [[Klinefelter Syndrome]]. Diseases of the [[hypothalamus]] or [[pituitary]] can also lead to low testosterone. Abuse of anabolic androgenic steroids (AAS) has a similar effect. Mutations to androgen receptors, such as those found in [[Kennedy disease]] can also cause gynecomastia.
Although stopping these medications can lead to regression of the gynecomastia, surgery is sometimes necessary to eliminate the condition.
Repeated topical application of products containing [[Lavender oil|lavender]] and [[tea tree oil]]s among other unidentified ingredients to three prepubescent males coincided with gynecomastia; it has been theorised that this could be due to their estrogenic and antiandrogenic activity. However, other circumstances around the study are not clear, and the sample size was insignificant so serious scientific conclusions cannot be drawn.<ref>{{cite journal |author=Henley D, Lipson N, Korach K, Bloch C |title=Prepubertal gynecomastia linked to lavender and tea tree oils |journal=N Engl J Med |volume=356 |issue=5 |pages=479–85 |year=2007 |pmid=17267908 |doi=10.1056/NEJMoa064725}}</ref>
==Diagnosis==
The condition usually can be diagnosed by examination by a [[physician]]. Occasionally, imaging by [[X-ray]]s or [[ultrasound]] is needed to confirm the [[diagnosis]]. Blood tests are required to see if there is any underlying disease causing the gynecomastia.
==Prognosis==
Gynecomastia is not physically harmful, but in some cases can be an indicator of other more dangerous underlying conditions. Growing [[glandular tissue]], typically from some form of hormonal stimulation, is often tender or painful. Furthermore, it can frequently present social and psychological difficulties for the sufferer.<ref>{{cite web | url = http://www.annalsplasticsurgery.com/pt/re/annps/abstract.00000637-200408000-00001.htm;jsessionid=F9bRttLWlcgHnBWVVgG3xcHwF1KbpJTPbgyLjKvQJXG977J7s1pP!1570379021!-949856144!8091!-1 | title = ''Gynecomastia: An Outcome Analysis'' | author = Wiesman, IM. et al.}}</ref> Weight loss can alter the condition in cases where it is triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss. Massive weight loss can result in sagging tissues about the chest, chest [[ptosis (breasts)|ptosis]], or drooping chest.
==Treatment==
Treating the underlying cause of the gynecomastia may lead to improvement in the condition. Patients should talk with their doctor about revising any medications that are found to be causing gynecomastia; often, an alternative medication can be found that avoids gynecomastia side-effects, while still treating the primary condition for which the original medication was found not to be suitable due to causing gynecomastia side-effects (e.g., in place of taking spironolactone the alternative eplerenone can be used.) [[Selective estrogen receptor modulator]] medications, such as [[tamoxifen]] and [[clomiphene]], or [[androgen]]s or [[aromatase inhibitor]]s such as [[Letrozole]] are medical treatment options, 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]], gland excision, skin sculpture, [[Breast reduction|reduction mammoplasty]], or a combination of these surgical techniques) the only treatment option. Many American insurance companies deny coverage for surgery for gynecomastia treatment on the grounds that it is a cosmetic procedure. [[Radiation therapy]] is sometimes used to prevent gynecomastia in patients with prostate cancer prior to estrogen therapy. [[Compression garment|Compression garments]] can camouflage chest deformity and stabilize bouncing tissue bringing emotional relief to some. There are also those who choose to live with the condition.
==References==
{{Reflist|2}}
[http://www.childrenshospital.org/az/Site978/mainpageS978P0.html What is gynecomastia?] Children's Hospital Boston
==See also==
*[[Male bra]]
*[[Male lactation]]
{{Diseases of the pelvis, genitals and breasts}}
[[Category:Andrology]]
[[Category:Breast]]
[[Category:Endocrinology]]
[[Category:Medical conditions related to obesity]]
[[ar:تثدي الرجل]]
[[bg:Гинекомастия]]
[[de:Gynäkomastie]]
[[es:Ginecomastia]]
[[fr:Gynécomastie]]
[[it:Ginecomastia]]
[[nl:Gynecomastie]]
[[ja:女性化乳房]]
[[pl:Ginekomastia]]
[[pt:Ginecomastia]]
[[ru:Гинекомастия]]
[[fi:Gynekomastia]]
[[sv:Gynekomasti]]
[[tr:Jinekomasti]]