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GynecomastiaN62.x

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Breast augmentation of the man,

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DefinitionThis section has been translated automatically.

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.

EtiopathogenesisThis section has been translated automatically.

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

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

Intoxicant

Cannabis (marijuana, hashish)
Heroin

Other:

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

ManifestationThis section has been translated automatically.

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.

Clinical featuresThis section has been translated automatically.

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

HistologyThis section has been translated automatically.

Hyperplasia of the gangetic epithelia and myoepithelial cells.

DiagnosisThis section has been translated automatically.

Exclusion of a malignancy by sonography, mammography, if necessary bioptic securing or fine needle aspiration.

Differential diagnosisThis section has been translated automatically.

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.

TherapyThis section has been translated automatically.

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.

Progression/forecastThis section has been translated automatically.

Gynecomastia is not pathological in every case. In infancy and puberty it is physiological and usually self-limiting. It is also not considered pathological in the senium.

LiteratureThis section has been translated automatically.

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

Authors

Last updated on: 29.10.2020

Author: Prof. Dr. med. Peter Altmeyer