Gynecomastia

Gynecomastia is a unilateral or bilateral enlargement of the mammary glands in men.

There is no exact data on the prevalence of gynecomastia, but it is quite common and is not a rare condition.

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Causes gynecomastia

Pathological gynecomastia develops as a result of the following pathological conditions:

• hormonally active tumors (testicles, adrenal cortex, ectopic tumors of the lungs, liver, kidneys);
• endocrine diseases accompanied by androgen deficiency;
• genetic diseases (Klinefelter syndrome, XX-male);
• severe systemic diseases;
• taking certain medications (cimetidine, spironolactone, tricyclic antidepressants, cotoconazole, etc.).

Physiological gynecomastia develops as a result of an imbalance of sex hormones.

In 30% of cases, the cause of gynecomastia cannot be determined.

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Pathogenesis

Gynecomastia is caused by the proliferation of previously inactive glandular tissue, as well as hyperplasia of adipose tissue.

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Symptoms gynecomastia

Often, breast enlargement may be the only symptom of the disease. In some cases, in addition to breast enlargement, there is also a pain syndrome - palpation of the mammary glands is painful. In all cases, a thorough examination is necessary for the possible identification of the most characteristic symptoms and syndromes caused by an imbalance of sex hormones, such as:

• sexual dysfunction syndrome: decreased libido, worsening erection, decreased intensity of orgasm;
• CNS damage syndrome: increased irritability, decreased ability to concentrate, sleep disturbance;
• depressive syndrome;
• catabolic syndrome: decreased muscle mass and strength, osteoporosis;
• reduction of genital hair;
• decrease in the size and density of the testicles.

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Forms

Pathogenetically, gynecomastia is divided into the following types:

• physiological:
• gynecomastia in newborns;
• adolescent gynecomastia (pubertal-juvenile);
• age-related (gynecomastia in the elderly);
• pathological.

According to localization, gynecomastia is divided into:

• one-sided (left-sided, right-sided);
• two-sided

Based on the nature of tissue development in the mammary glands, gynecomastia is divided into:

• true - the development of glandular tissue takes place;
• false - there is development of adipose tissue.

In cases where it is impossible to establish the causes of gynecomastia, it is called idiopathic gynecomastia.

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Complications and consequences

Rarely - changes in liver function tests.

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Diagnostics gynecomastia

Gynecomastia is diagnosed without any difficulties: the diagnosis can be established based on palpation of the mammary glands. A necessary part of the examination for gynecomastia is palpation of the testicles - to exclude an active tumor of the testicles, as well as Klinefelter's syndrome, which is characterized by hypoplastic and dense testicles.

The scope of laboratory tests is determined based on the clinical situation and may include:

• determination of the level of LH, FSH, tostosterone, estradiol, TTT, prolactin in the blood;
• determination of karyotype (if LH and FSH levels are elevated) to exclude Klinefelter syndrome;
• biochemical blood test (to assess kidney and liver function).

Differential diagnosis

When palpating, it is necessary to differentiate between gynecomastia and lipomastia - excessive deposition of fatty tissue in the mammary glands. If it is difficult to distinguish fatty tissue from glandular tissue when palpating, it is possible to conduct an ultrasound of the mammary glands or mammography.

Treatment gynecomastia

If gynecomastia develops as a result of endocrine diseases (hypothyroidism, hyperprolactinemia, hypogonadism) or liver diseases, then the main efforts should be aimed at their cure.

In case of imbalance of sex hormones, namely, a violation of the ratio between the level of androgens and estrogens in the body towards the predominance of estrogens, the goal of pharmacotherapy is to restore the balance between sex hormones.

Androgenic drugs are used, among which mesterolone deserves special attention, as it is not subject to aromatization into estrogens and, therefore, increases the androgen/estrogen ratio in favor of androgens:

Mesterolone orally, regardless of food intake, 25 mg 1-3 times a day, 3 months.

Evaluation of treatment effectiveness

The effectiveness of treatment is assessed 3 months after its start based on the clinical picture. If there is no reduction in mammary glands, it is necessary to re-determine the levels of testosterone and estradiol in the blood to decide on increasing the dose of androgenic drugs.

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Errors and unjustified appointments

The most common errors are related to the unjustified prescription of a number of drugs whose effectiveness for a given disease has not been proven, such as:

• danazol;
• testolactone;
• clomiphene,
• tamoxifen.

Forecast

Physiological gynecomastia has a good prognosis, in most cases there is a spontaneous reduction in the mammary glands. Pubertal gynecomastia disappears within 2-3 days after its appearance. In the case of pathological gynecomastia, the effectiveness of drug treatment is determined by the severity of the disease: with a significant increase in the mammary glands, drug treatment is ineffective, with a moderate increase, the effectiveness of treatment is 50-60%.

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