Clinical Aspects of Gynecomastia in Adult Males: A Multicenter Study

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

 

Gynecomastia, defined as the benign proliferation of breast glands in males, is a common complaint that produces anxiety and discomfort and it may be the expression of a clinically relevant disease.

The hormones involved in breast tissue physiology may be stimulatory (as estradiol and progesterone) or inhibitory (as testosterone), acting directly through their specific receptors at this level. Receptors for insulin-like growth factor 1 (IGF-1), IGF-2 , luteinizing hormone, and human chorionic gonadotropin have also been detected in breast tissue. Estrogens and progesterone apparently require the presence of growth hormone and IGF-1 to exert their stimulatory action on the breast. Hyperprolactinemia may indirectly cause gynecomastia by suppressing gonadotropin-releasing hormone (GnRH) release, resulting in central hypogonadism, although prolactin receptors have also been detected in benign and malignant breast tissue. At breast level, prolactin might modulate progesterone and androgen receptors expression (increasing the former and reducing the latter). Furthermore, prolactin stimulates epithelial cell proliferation only in the presence of estrogen and enhances lobuloalveolar differentiation only with concomitant progesterone.

Gynecomastia may result from an excess of estrogens (obesity, tumors, and exogenous sources), androgen deficiency (hypogonadism), hormone resistance, or an altered ratio of estrogens to androgens (refeeding, liver disease, and renal failure). This study looked at the incidence and causes of gynecomastia in men 18-

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 frequently 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.

Reference:

BioMed Research International
Volume 2018, Article ID 8364824, 7 pages
Full paper
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