madman
Super Moderator
Abstract
Introduction: Gynaecomastia (GM) is a benign unilateral or bilateral proliferation of the glandular tissue of the breast in males. Its development during adolescence is usually considered a physiological phenomenon and is expected to resolve within months. Sometimes, however, it is due to pathological conditions or diseases, and it is not uncommon for these not to be recognized promptly. The present study aims to investigate the causes of prepubertal and pathological pubertal GM, its association with obesity, the age of appearance, and whether GM has a psychological impact on boys and adolescents admitted to the endocrine department.
Material and methods: A total of 157 boys and adolescents with GM were included in a cross-sectional retrospective study in a single tertiary center for endocrine diseases. Patients were evaluated by anthropometric measurements, serum hormonal levels, and a questionnaire.
Results: In the period 2009-2018 a total of 157 boys and adolescents were diagnosed with GM (76.43% obese, 3.18% — overweight). Twelve (7.64 %, mean age of GM development 7.53 years) were prepubertal, 5.09% with primary or secondary testicular damage, 5.73% with hypogonadotropic hypogonadism, 11.48% with elevated prolactin level, and 110 boys (70.06%) with physiological pubertal GM. A statistically significant difference was found between the age of development of physiological GM — 11.85 years (9.35–16.92) and hypergonadotropic — 13.57 years (10-16.25) (p=0.006) and hypogonadotropic — 12.77 years (10.50–14.0) (p = 0.028) hypogonadism. The onset of pubertal GM in normal-weight boys was 13.13 years, and in obese/overweight it was 11.69 years (p < 0.001). Eighty-four patients (53.5%) expressed having a psychological burden of GM, 12.1% consulted because of its development, 8.2% it led to the cessation of sports, and 2.5 % changed their clothes.
Conclusions: Prepubertal and pubertal GM has a high association with obesity. Excess adipose tissue has an impact on the age of development in both groups. Nearly a quarter of pubertal cases are due to pathological conditions, and those are often diagnosed more than 18 months after the appearance of breasts. Hence, although a greater number of pubertal GMs are physiological, it may be reasonable for adolescents to be evaluated within the first 6 months of breast development so as not to delay the diagnosis of pathologic causes. Additionally, we found that GM has a complex influence on the psychological state of boys and adolescents.
Introduction
Gynaecomastia (GM) is a unilateral or bilateral benign proliferation of the glandular tissue of the breast in males [1]. During 3 periods of an individual’s life GM is considered a physiological phenomenon — in the neonatal period, during adolescence, and in senile men.
*GM itself is not a disease but rather a condition or symptom of an underlying disease that has led to an altered balance, at the level of breast tissue, between the level and effect of estrogens and androgens due to an absolute increase in estrogen levels, absolute or relative decrease in androgen levels, altered bioavailability, disorders of androgen receptors, or hypersensitivity of the glandular tissue [2, 3, 4].
Overweight and obesity among children and adolescents play an important role in the development of GM [5, 6]. The causes of pathological GM and its incidence in adult men are widely known. However, for children and adolescents, there are almost no accurate data on the prevalence of different causes of pathological GM. The aim of the study is to investigate the causes of prepubertal and pathological pubertal GM, and its association with obesity among patients admitted to endocrinology clinics. In addition, an analysis of its psychological impact was performed.
Conclusions
In conclusion, in our study, nearly a quarter of pubertal cases are due to pathological conditions, which are often diagnosed more than 18 months after the appearance of breasts. Hence, although a greater number of pubertal GMs are physiological, it may be reasonable for adolescents to be evaluated within the first 6 months of breast development so as not to omit pathological causes and delay the diagnosis. Additionally, we found that GM has a complex influence on the psychological state of boys and adolescents. Perhaps the early establishment of the patient’s condition may have a positive impact on his psychological state, behavior, and habits, especially in obese boys with pubertal GM.
Introduction: Gynaecomastia (GM) is a benign unilateral or bilateral proliferation of the glandular tissue of the breast in males. Its development during adolescence is usually considered a physiological phenomenon and is expected to resolve within months. Sometimes, however, it is due to pathological conditions or diseases, and it is not uncommon for these not to be recognized promptly. The present study aims to investigate the causes of prepubertal and pathological pubertal GM, its association with obesity, the age of appearance, and whether GM has a psychological impact on boys and adolescents admitted to the endocrine department.
Material and methods: A total of 157 boys and adolescents with GM were included in a cross-sectional retrospective study in a single tertiary center for endocrine diseases. Patients were evaluated by anthropometric measurements, serum hormonal levels, and a questionnaire.
Results: In the period 2009-2018 a total of 157 boys and adolescents were diagnosed with GM (76.43% obese, 3.18% — overweight). Twelve (7.64 %, mean age of GM development 7.53 years) were prepubertal, 5.09% with primary or secondary testicular damage, 5.73% with hypogonadotropic hypogonadism, 11.48% with elevated prolactin level, and 110 boys (70.06%) with physiological pubertal GM. A statistically significant difference was found between the age of development of physiological GM — 11.85 years (9.35–16.92) and hypergonadotropic — 13.57 years (10-16.25) (p=0.006) and hypogonadotropic — 12.77 years (10.50–14.0) (p = 0.028) hypogonadism. The onset of pubertal GM in normal-weight boys was 13.13 years, and in obese/overweight it was 11.69 years (p < 0.001). Eighty-four patients (53.5%) expressed having a psychological burden of GM, 12.1% consulted because of its development, 8.2% it led to the cessation of sports, and 2.5 % changed their clothes.
Conclusions: Prepubertal and pubertal GM has a high association with obesity. Excess adipose tissue has an impact on the age of development in both groups. Nearly a quarter of pubertal cases are due to pathological conditions, and those are often diagnosed more than 18 months after the appearance of breasts. Hence, although a greater number of pubertal GMs are physiological, it may be reasonable for adolescents to be evaluated within the first 6 months of breast development so as not to delay the diagnosis of pathologic causes. Additionally, we found that GM has a complex influence on the psychological state of boys and adolescents.
Introduction
Gynaecomastia (GM) is a unilateral or bilateral benign proliferation of the glandular tissue of the breast in males [1]. During 3 periods of an individual’s life GM is considered a physiological phenomenon — in the neonatal period, during adolescence, and in senile men.
*GM itself is not a disease but rather a condition or symptom of an underlying disease that has led to an altered balance, at the level of breast tissue, between the level and effect of estrogens and androgens due to an absolute increase in estrogen levels, absolute or relative decrease in androgen levels, altered bioavailability, disorders of androgen receptors, or hypersensitivity of the glandular tissue [2, 3, 4].
Overweight and obesity among children and adolescents play an important role in the development of GM [5, 6]. The causes of pathological GM and its incidence in adult men are widely known. However, for children and adolescents, there are almost no accurate data on the prevalence of different causes of pathological GM. The aim of the study is to investigate the causes of prepubertal and pathological pubertal GM, and its association with obesity among patients admitted to endocrinology clinics. In addition, an analysis of its psychological impact was performed.
Conclusions
In conclusion, in our study, nearly a quarter of pubertal cases are due to pathological conditions, which are often diagnosed more than 18 months after the appearance of breasts. Hence, although a greater number of pubertal GMs are physiological, it may be reasonable for adolescents to be evaluated within the first 6 months of breast development so as not to omit pathological causes and delay the diagnosis. Additionally, we found that GM has a complex influence on the psychological state of boys and adolescents. Perhaps the early establishment of the patient’s condition may have a positive impact on his psychological state, behavior, and habits, especially in obese boys with pubertal GM.
