Gynaecomastia with oligospermia: an unusual complication of low-dose methotrexate for pustular psoriasis.

Pandhi, Deepika; Gupta, Rahul; Singal, Anjum

doi:10.1111/j.1365-2230.2005.01925.x

Cited by 23 publications

(14 citation statements)

References 7 publications

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“…In all 11, a recurrence of breast enlargement and/or mastodynia was reported after the drug was restarted. The drugs involved were nifedipine [ 32 ], sunitinib [ 103 ], isoniazid [ 67 ], fenofibrate [ 40 ], metronidazole [ 77 ], ranitidine [ 86 ], finesteride [ 41 ] (two subjects), methotrexate [ 110 ], omeprazole [ 111 ], and amlodipine [ 5 ]. A proposed mechanism in each case was not presented.…”

Section: Resultsmentioning

confidence: 99%

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Gynecomastia and drugs: a critical evaluation of the literature

Nuttall

Warrier

Gannon

2015

Eur J Clin Pharmacol

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PurposeA large number of medications have been implicated in the genesis of gynecomastia. However, gynecomastia is common in men, asymptomatic, increases with age, and is considered to be due to an increased estradiol/testosterone ratio. This complicates the interpretation of medication-related gynecomastia. Therefore, we have reviewed the literature in order to assess the data relating gynecomastia onset with utilization of specific medications.MethodsThe literature was searched in PubMed and the Ovid/Medline databases from the 1946 to January 2015 with the search terminology of “gynecomastia, drugs/medications.” A few other articles were found and included.ResultsOne hundred ten publications were reviewed. Sixty-three were single case reports. There were 24 population-based studies of which 8 were HIV-infected patients treated with antiretroviral agents. Among the case reports, 49 were for individual medications, and 2 were reports of antineoplastic or antiretroviral drug regimens. In the great majority, mastodynia with or without breast enlargement was present and referred to as gynecomastia. Generally, hormonal profiles could not explain the breast enlargement. The pain/tenderness and breast enlargement resolved spontaneously over time.ConclusionMany different medications have been associated with the presence of “gynecomastia.” Generally, it presents as a syndrome characterized by a single painful/tender breast (mastodynia) associated with breast enlargement and is transient. We suggest that these cases be referred to as an acute gynecomastia syndrome. This syndrome also occurs independent of medication use. Thus, in an individual patient, whether it is medication induced often remains uncertain. The pathogenesis remains unknown.

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Section: Resultsmentioning

confidence: 99%

“…A proposed mechanism in each case was not presented. In one report when the patient was restarted on metronidazole [ 77 ], he complained of bilateral breast tenderness within 3 weeks of restarting therapy, and the drug was stopped. Palpable breast tissue had not occurred.…”

Section: Resultsmentioning

confidence: 99%

Gynecomastia and drugs: a critical evaluation of the literature

Nuttall

Warrier

Gannon

2015

Eur J Clin Pharmacol

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“…48 male MTX exposures were included (table 1). There were two case reports of oligospermia associated with MTX: One resolved on stopping methotrexate and recurred when restarted (48); the other was unaffected by stopping methotrexate (49). The other 5 papers (n=46 exposures) however, all concluded that there was no impact of methotrexate on fertility.…”

Section: Fertilitymentioning

confidence: 99%

Safety of anti-rheumatic drugs in men trying to conceive: A systematic review and analysis of published evidence

Mouyis

Flint

Giles

2019

Seminars in Arthritis and Rheumatism

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There is limited evidence relating to the impact of disease modifying anti-rheumatic drugs (DMARDs) upon male fertility and peri-conception paternal exposure in men with rheumatic disease. Therefore, we conducted a systematic review of available evidence to update information on this subject and guide paternal counselling. A systematic search of PubMed and Embase was carried out up to September 2017, to find relevant peer-reviewed papers, using keywords for fertility/spermatogenesis/conception, men, and disease modifying or biologic drugs commonly prescribed in patients with rheumatic disease. The search yielded 724 papers, and the titles/abstracts were screened independently by 2 authors, duplicates removed and 233 potentially relevant papers selected for full text review. A total of 84 papers were included in the final analysis which covered the impact on fertility of over 611 male exposures to relevant drugs, and over 5986 pregnancies conceived during paternal exposure to (or within 3 months of stopping) these drugs. Aside from the known adverse impact of cyclophosphamide and sulfasalazine on spermatogenesis, overall there was no firm evidence of harm to fertility or pregnancy outcomes with paternal exposure to anti-TNF therapies, abatacept, rituximab, azathioprine, cyclosporine A, hydroxychloroquine, leflunomide, methotrexate or mycophenolate mofetil. There was no evidence found pertaining to the effects of male exposure to IVIG, tacrolimus, golimumab, anakinra or belimumab on fertility or pregnancy outcomes. These results provide further reassurance as to the safety of many DMARDs for men trying to conceive and will be useful when counselling men about risks of anti-rheumatic drugs to fertility and pregnancies, and following accidental conception.

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“…In other reports it has been suggested that MTX-induced gynecomastia is due to increased breast tissue sensitivity to estrogen. 4,5,8 Details of the mechanism by which MTX causes gynecomastia are not currently well understood. In a laboratory animal study, the toxic effects of parenteral MTX on rabbit testis reportedly include decreased serum testosterone levels, oligospermia, and elevated serum follicle-stimulating hormone (FSH) levels.…”

Section: Mtxmentioning

confidence: 99%

“…Several cases of sexual dysfunction and gynecomastia in men undergoing MTX treatment have been reported. [1][2][3][4][5] We report a patient with RA in whom gynecomastia developed within a few months of beginning of oral low-dose MTX therapy.…”

Section: Introductionmentioning

confidence: 99%

Gynecomastia associated with low-dose methotrexate therapy for rheumatoid arthritis

et al. 2007

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A 68-year-old man with a 3-year history of rheumatoid arthritis (RA) developed gynecomastia 3 months after beginning oral low-dose methotrexate (MTX) therapy. Four months after MTX therapy was discontinued, the gynecomastia symptoms improved. Only eight cases of gynecomastia resulting from low-dose MTX administration have been reported worldwide, and no cases have previously been reported in Japan. Although it occurs infrequently, gynecomastia resulting from low-dose MTX therapy should be considered in male patients with RA.

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Gynaecomastia with oligospermia: an unusual complication of low-dose methotrexate for pustular psoriasis.

Cited by 23 publications

References 7 publications

Gynecomastia and drugs: a critical evaluation of the literature

Gynecomastia and drugs: a critical evaluation of the literature

Safety of anti-rheumatic drugs in men trying to conceive: A systematic review and analysis of published evidence

Gynecomastia associated with low-dose methotrexate therapy for rheumatoid arthritis

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