Gynecomastia N62.x

Enlargement of the male mammary gland on one or both sides by increasing the glandular tissue or by increasing the fat deposit in the breast region.

Causes of pathological gynecomastia (varies according to scale HC et al. 2018)

Idiopathic gynecomastia

• Familial gynecomastia of unknown genesis

Disturbance of the androgen-estrogen balance:

• Persistent Puberty Gynecomastia
• Therapeutic estrogen supply
• Hyperprolactinaemia (see prolactin below)
• Klinefelter's syndrome,
• Leydig cell tumor
• Sertoli cell tumor
• Adrenal Cattle Tumours
• Hyperthyroidism
• Hypogonadism (hypo-, hypergonadotropic)
• Ectopes h CG production by malignant tumors (paraneoplastic syndrome) bronchial carcinoma, hepatocellular carcinoma, renal cell carcinoma.

General diseases

• Hepatic decompensation,
• Renal insufficiency
• Malnutrition or weight gain after malnutrition
• AIDS

Drug therapies:

H2-Blocker

• Cimetidine
• Ranitidine

Chemotherapeutics

• Alkylanzias
• Methotrexate
• Vinca alkaloids
• Sex hormones and their modulators:
• Anabolic steroids: Testosterone treatment or abuse of anabolic steroids can also promote breast growth
• Estrogens
• HCG
• Ketoconazole
• 5-alpha-reductase inhibitors(finasteride or dutasteride)
• Spironolactone
• Hormone withdrawal in advanced prostate carcinoma

Cardiac:

• Digitalis
• Beta-receptor blockers (Atenolol and Propranolol)
• Calcium antagonists
• ACE inhibitors
• Reserpin

Phytotherapeutics with oestrogen-like active ingredients

• Lavender
• Tea tree oil
• Phytoestrogens

Intoxicant

• Cannabis (marijuana, hashish)
• Heroin

Other:

• vitamin B2
• Isoniazid (INH)
• Allopurinol
• Protease inhibitors
• Nucleosidal reverse transcriptase inhibitors.
• Metronidazole

Physiological: neonatal age (up to 90% of male newborns develop a harmless and rapidly reversible gynecomastia), puberty (40-70% of adolescents are affected) The prevalence in the adult population is reported to be 30-60%. It is highest in the senium.

One-sided or double-sided enlargement of the nipple and areola. In strands the glandular tissue is enlarged and painfully palpated. Galactorrhea is very rarely observed.

To objectify a gynaecomastia, various measures are suggested:

• Thickness of a horizontal skin fold to be palpated, including the nipple (>2cm, in obesity >3cm)
• Diameter of the areola (>3cm)

The classification is generally based on the stadium classification according to Tanner:

• B1: No glands palpable
• B2: areola enlarged, gland bulging
• B3: Glands> areola
• B4: Solid gland
• B5: Corresponds to the female breast

• Gynecomastic fat breast in general obesity (pseudogynecomastia or lipomastia).
• In case of unilateral or asymmetrical gynaecomastia: breast carcinoma (rough nodular infiltrates, retraction and mammary secretion)
• Fibrosis
• Fibroadenomas.

• The treatment depends on the exclusion of possible causes according to individual aspects (psychological strain on the patient through female appearance). As there is a high tendency to spontaneous regression, a wait-and-see attitude is justified.
• Identification of the trigger and exclusion of the same.
• If the cause is mainly medication, discontinuation of the medication causing the problem.
• Drug therapy: Smaller clinical studies and case series have investigated different concepts of drug therapy. However, the data situation is poor. The best evidence is for the use of anti-estrogenic therapies, e.g. with tamoxifen, danazol and the aromatase inhibitors testolactone and anastronazole.
• Surgical removal of the glandular tissue in the case of prolonged (6-12 months) fibrosing gynecomastia.

1. Evans DL et al (2002) Breast enlargement in 13 men who were seropositive for human immunodeficiency virus. Clin Infect Dis 35: 1113-1119
2. Ersoz H (2002) Causes of gynaecomastia in young adult males and factors associated with idiopathic gynaecomastia. Int J Androl 25: 312-316
3. Ferrando J et al (2002) Unilateral gynecomastia induced by treatment with 1 mg of oral finasteride. Arch Dermatol 138: 543-544
4. Paech V et al (2002) Gynaecomastia in HIV-infected men: association with effects of antiretroviral therapy. AIDS 16: 1193-1195
5. Seibel V et al (1998) Incidence of gynecomastia in dermatology patients. dermatologist 49: 382-387
6. Zimmerman RL et al (2000) Cytologic atypia in a 53-year-old man with finasteride-induced gynecomastia. Arch Catholic Lab Med 124: 625-627