A Family Doctor's Tale - GYNECOMASTIA

DOC I HAVE A LUMP IN MY MALE BREAST AREA

My own brother has unilateral gynecomastia at the age of 18 years probably from eating chicken injected with female hormones. He was operated and had the excess breast tissue removed without any complications.
Recently one of my patient was given Aldactone or spironactone for 3 months by a heart specialist. He developed swelling and pain on the right breast area. I reassured him and told him that it was due to the medicine.He was worried that there may be cancer of the breast.

Gynecomastia is unilateral or bilateral enlargement in the glandular tissue of the breast in males.


The causes of gynecomastia is not completely clear.
It is believed to be caused by an imbalance of sex hormones especially during puberty.


A.Hormonal:

1.In  male babies the painless swelling of the breast may occur due to the effects of the mother's female hormones.The swelling usually subsides after a few weeks.


2.At Puberty for boys the development of breasts is due to the increased ratio of free estrogen to free testosterone. 
In most cases the breasts may disappear after 1 year.


3.Some cases of Gynecomastia may be due to ingestion of female hormones injected into chicken and ducks


B.Genetic

Some cases of  male hypogonadism causing reduced testosterone.


C.Liver cirrhosis

Failure of metabolism of circulating estrogen can increase the female hormones in the adults and cause Gynecomastia


D.Medications:

a.Spironolactone
b.digoxin
c.cimetidine
d.maxolon


E.Tumors

Testicular or Pituitary Tumors may cause increased estrogen and reduced testosterone and hence increase the production of breasts.


The Symptoms of Gynecomastia are:

1.Pain usually present in all cases except in babies


2.swelling of the breasts or the nipple area in males


Signs:

1.redness of the breast


2.swelling of the breast tissue


3.Local tenderness of swollen area


Diagnosis is based on:
1. clinical features


2. Endocrine blood tests including HCG levels


3. Liver function tests


4.Ultrasound scan of the breasts


Treatment is by:
1.treating the underlying cause


2.Medications causing Gynecomastia should be stopped.


3.cosmetic surgery-liposuction, gland excision, reduction mammoplasty,


4.Tamoxifen if necessary


5.Radiation therapy may prevent gynecomastia in patients with prostate cancer prior to estrogen therapy.


Most cases has good prognosis.


Adolescent cases may regress spontaneously.