Gynecomastia: physiopathology, evaluation and treatment

Abstract

Gynecomastia (GM) is characterized by enlargement of the male breast, caused by glandular proliferation and fat deposition. GM is common and occurs in adolescents, adults and in old age. The aim of this review is to discuss the pathophysiology, etiology, evaluation and therapy of GM. A hormonal imbalance between estrogens and androgens is the key hallmark of GM generation. The etiology of GM is attributable to physiological factors, endocrine tumors or dysfunctions, non-endocrine diseases, drug use or idiopathic causes. Clinical evaluation must address diagnostic confirmation, search for an etiological factor and classify GM into severity grades to guide the treatment. A proposal for tailored therapy is presented. Weight loss, reassurance, pharmacotherapy with tamoxifen and surgical correction are the therapeutic options. For long-standing GM, the best results are generally achieved through surgery, combining liposuction and mammary adenectomy. ReSUMOA ginecomastia (GM) é caracterizada pelo aumento do volume mamário em homens, provocada por proliferação glandular e depósito de gordura. É comum e pode ocorrer em adolescentes, adultos e idosos. O objetivo desta revisão é discutir a fisiopatologia, etiologia, avaliação clínica e terapia da GM. Um desequilíbrio entre estrogênios e androgênios é reconhecido como a condição fundamental para a determinação do quadro, podendo ser atribuído a fatores fisiológicos, tumores ou distúrbios endócrinos, doenças não-endócrinas, uso de drogas ou ser de causa idiopática. A avaliação clínica deve enfocar a confirmação diagnóstica, a procura de uma causa específica e a classificação em graus de gravidade para orientar o tratamento. Um roteiro de conduta individualizada é apresentado, variando entre perda de peso e explicações verbais, tratamento com tamoxifeno e correção cirúrgica. Para casos de GM persistente, os melhores resultados são obtidos em geral mediante abordagem cirúrgica, combinando lipoaspiração e adenectomia mamária.

Risperidone Use in Children: Gynecomastia, Hyperprolactinemia, and Other Controversies

“…[6][7][8][9] Pubertal gynecomastia can last for 6 to 12 months and then spontaneously regress in 95% of cases. 10 It is distinguished from pseudogynecomastia, which is an enlargement of breast area due to accumulation of fat, often in obese individuals. [6][7][8][9][10] In addition to physiological gynecomastia, gynecomastia can also occur due to secondary causes, such as being induced by legal or illegal drugs or due to certain pathological conditions.…”

“…10 It is distinguished from pseudogynecomastia, which is an enlargement of breast area due to accumulation of fat, often in obese individuals. [6][7][8][9][10] In addition to physiological gynecomastia, gynecomastia can also occur due to secondary causes, such as being induced by legal or illegal drugs or due to certain pathological conditions. The conditions most relevant in children are hypogonadism from causes such as mumps, hyperthyroidism, and conditions such as Klinefelter's syndrome in which 80% of the children affected may exhibit gynecomastia.…”

“…[6][7][8][9][10] Because many children who suffer from severe mental illnesses require treatment with neuroleptics during their pubertal years, distinguishing between naturally occurring gynecomastia and one that may be triggered by neuroleptic treatment during puberty may be challenging even for the best and most careful of physicians. 6 One factor that may help in distinguishing a naturally occurring pubertal gynecomastia from one that is induced by medicines is the history of gynecomastia developing within 12 months of the particular medicine being started.…”

“…[6][7][8][9][10]17,18 The hormonal imbalance in favor of estrogen is believed to trigger glandular and ductal hyperplasia, causing gynecomastia. 6,8 There is evidence that obesity and high body mass index are associated not only with pseudogynecomastia, but with gynecomastia as well.…”

Childhood Gynecomastia: A Mini Review

“…Activation of PRL, also, leads to decreased androgens and increased estrogen and progesterone receptors. The role of PRL, progesterone and other growth factors such as insulin like growth factors (IGF-1) and epidermal growth factor (EGF), in the development of gynecomastia need to be clarified [5][6][7][8][9][10].…”