Clinical and Etiological Aspects of Gynecomastia in Adult Males: A Multicenter Study

Abstract

Objectives To evaluate the characteristics of presentation, biochemical profile, and etiology of gynecomastia in adults. Methods Medical records of 237 men aged 18-85 years with gynecomastia were evaluated. Results Highest prevalence of gynecomastia was observed between 21 and 30 years (n = 74; 31.2%). The most common presenting complaints were aesthetic concerns (62.8%) and breast pain (51.2%). 25.3% of the subjects had a history of pubertal gynecomastia. 56.5% had bilateral gynecomastia. 39.9% were overweight and 22.8% were obese. The etiology could not be identified in 45.1% of the cases; the most frequent identified causes were anabolic steroids consumption (13.9%), hypogonadism (11.1%), and use of pharmaceutical drugs (7.8%). Patients with bilateral gynecomastia had a longer history of disease, higher BMI, and lower testosterone levels. Conclusions Patients with gynecomastia presented more often with aesthetic concerns and secondarily with breast pain. The most frequent final diagnosis was idiopathic gynecomastia, whereas the most frequent identified etiologies were anabolic steroids consumption, hypogonadism, and use of pharmaceutical drugs. Despite the low frequency of etiologies such as thyroid dysfunction or adrenal carcinoma, we emphasize the importance of a thorough assessment of the patient, as gynecomastia may be the tip of the iceberg for the diagnosis of treatable diseases.

Causes and Metabolic Consequences of Gynecomastia in Adult Patients

“…Most of the investigated adult patients presented with bilateral GM, as in a former study on adolescent boys in the same population [6]. In opposite, the prevalence of unilateral and bilateral GM in other ethnic GM groups was almost similar [20].…”

Surgical Management of Gynecomastia: A Comprehensive Review of the Literature

“… 11 The final peak is found in older men (between 50 and 80 years), with the most frequent causes in this age group being hypogonadism and pharmaceutical drug use. 13 …”

Treatment of gynecomastia with prednisone: case report and literature review

“…Pain may be present if a new onset of the disease occurs. 11 Moreover, limited laboratory tests and imaging workup to determine the potential reasons for gynecomastia need to be performed. Laboratory testing to measure hepatic transaminase, serum creatinine, and thyroid-stimulating hormone levels in patients should be conducted.…”

“…The differential diagnosis of gynecomastia, as demonstrated in a series of adult patients with gynecomastia, includes approximately 9% of all-cause hyperprolactinemia. 11 Based on previous studies, hypogonadism and androgen deficiency were probably caused by hyperprolactinemia, and therefore, these conditions might alter the progesterone and androgen receptors, leading to gynecomastia. 15 Additionally, pituitary adenomas producing prolactin may also induce hyperprolactinemia.…”