SPOTTERS MEDICINE
GYNECOMASTIA
🔹 Definition:
Gynecomastia
is the benign enlargement of male breast tissue due to proliferation
of glandular tissue, often caused by an imbalance between estrogen and
androgen activity.
🔹 Types of Gynecomastia:
1.
Physiological:
o Neonatal: Maternal estrogen effect
o Pubertal: Transient hormonal imbalance
o Senile: Declining testosterone levels
2.
Pathological:
o Hormonal disorders (e.g.,
hyperthyroidism, hypogonadism)
o Chronic diseases (e.g., liver
cirrhosis, CKD)
3.
Pharmacological (Drug-induced):
o Spironolactone, ketoconazole
o Cimetidine, digoxin
o Anti-androgens, anabolic steroids
o Alcohol, marijuana
4.
Idiopathic:
o No identifiable cause
🔹 Causes:
- ↑ Estrogen production or activity
- ↓ Androgen production or activity
- Hormone-secreting tumors
(testicular, adrenal)
- Liver failure (↓ estrogen
clearance)
- Medications
🔹 Clinical Features:
- Bilateral or unilateral enlargement of male breast
- Rubbery, firm subareolar mass (not fatty)
- Tenderness or pain may be
present
- Usually symmetrical in
physiological types
- Rule out breast carcinoma
(hard, irregular, fixed mass)
🔹 Diagnosis:
- Clinical examination
- Hormonal profile: Testosterone,
LH, FSH, Estradiol
- Liver and renal function tests
- Ultrasound of testis (tumor suspicion)
- Mammography if carcinoma suspected
🔹 Differential Diagnosis:
- Pseudogynecomastia (fat
accumulation in obese males)
- Male breast cancer
- Breast abscess or lipoma
🔹 Treatment:
Physiological
gynecomastia:
- Usually resolves spontaneously
Pathological
or persistent cases:
- Treat underlying cause
- Stop causative drug
- Medical therapy:
- Tamoxifen (anti-estrogen)
- Clomiphene citrate
- Surgery (subcutaneous
mastectomy):
- For cosmetic or psychological
reasons
- Severe or long-standing cases
🔹 Prognosis:
- Excellent in physiological and
drug-induced cases
- Chronic cases may need surgical
correction
- Reassurance and education are
essential
DR.C.GANESAN M.D.
PROFESSOR OF MEDICINE
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