What is gynecomastia

Gynecomastia

English: gynecomastia

1 definition

Under one Gynecomastia one understands a unilateral or bilateral enlargement of the male mammary glands, which emanates from the glandular body.

2 classification

One differentiates:

  • Real gynecomastia: increase in breast tissue
  • False gynecomastia: accumulation of fatty tissue in the glandular body as a side effect of obesity. It is also known as adipomastia, pseudogynecomastia, or lipomastia.

3 causes

3.1 Physiological causes

There are many causes of gynecomastia. Physiologically, gynecomastia is found in up to 90% of newborns and in 40-70% of people during puberty. Gynecomastia is also common in older men. One differentiates accordingly:

  • Neonatal gynecomastia: A transient gynecomastia caused by the mother's female sex hormones that are transmitted to the newborn through the placenta.
  • Puberty gynecomastia: It develops in the course of puberty and usually disappears completely. In some cases it can persist. The cause is an increased expression of the insulin-like growth factor 1 (IGF-1) in connection with an increased estrogen and testosterone level.
  • Pseudogynecomastia: Develops from fat storage in the mammary gland in obese people with a body mass index (BMI) of around 30.
  • Old age gynecomastia: It is caused by the relatively higher proportion of fatty tissue in the total body mass of older people. This increases the conversion of androgens to estrogens, while the testicular androgen product kion decreases.

3.2 Pathological causes

Possible pathological causes include:

root cause Examples
General illnesses
Congenital diseases
Malignant diseases
Endocrine Disorders
Medication
  • Estrogens
  • Androgen receptor blockers: bicalutamide, flutamide, nilutamide, spironolactone, eplerenone, cyproterone
  • Androgen synthesis inhibitors: fluconazole, itraconazole, metronidazole, GnRH agonists (chronic) and antagonists
  • 5-alpha reductase inhibitors: finasteride, dutasteride
  • Steroids (especially for abuse)
  • H2 blockers: cimetidine, ranitidine
  • Proton pump inhibitors: e.g. omeprazole
  • digitalis
  • Phenytoin
  • and much more
Drugs
Other causes

4 pathogenesis

Pathogenesis Examples
Increased levels or effects of estrogen (hyperestrogenism)
Decreased levels or effects of androgens (hypogonadism)
Multifactorial
  • Obesity
  • Renal failure or hemodialysis
  • Cirrhosis of the liver
  • Starvation dystrophy in the recovery phase
  • Hyperprolactinemia
  • Hyperthyroidism
  • Drugs: ACE inhibitors, amiloride, calcium channel blockers, ciclosporin, diazepam, HAART, methyldopa, isoniazid, reserpine, risperidone, theophylline, tricyclic antidepressants, growth hormone
  • Drugs: alcohol, amphetamines, heroin

5 classification

5.1 ... according to Hall

  • Grade I: clinically only palpable enlargement of the glandular body
  • Grade II: magnification that can be determined by inspection
  • Grade III: corresponds to a female breast

5.2 ... according to Tanner

  • B1: no glandular body palpable
  • B2: Areola enlarged, gland bulging
  • B3: glandular bodies larger than areola
  • B4: solid glandular body
  • B5: corresponds to female breast

6 diagnostics

The following criteria apply to the objectification of gynecomastia:[1]

  • horizontal fold of skin including the nipple of 2 cm (3 cm for obesity)
  • or areola diameter> 3 cm.

6.1 Medical history

  • Symptoms, onset, course
  • Symptoms of androgen deficiency
  • Underlying diseases
  • Medication, drugs

6.2 Physical examination

6.3 Laboratory diagnostics

4 ml of serum are required for laboratory diagnosis of gynecomastia. The following values ​​are examined, which are intended to exclude breast or testicular tumors on the one hand and endocrinological causes on the other:

6.4 Imaging

6.5 Further investigations

7 differential diagnoses

The following differential diagnoses must be distinguished from gynecomastia, which are mostly localized on one side:

8 therapy

In gynecomastia, causal factors should be eliminated or treated. Physiological or idiopathic gynecomastia can be treated for cosmetic reasons or when pain occurs. In the case of gynecomastia during puberty, wait-and-see observation is recommended, as spontaneous regression (even months to years after puberty) can be expected.

8.1 Drug therapy

In the initial phase of gynecomastia (up to approx. 6 months), tamoxifen (10-20 mg / d) can be administered. The administration of clomiphene, danazol, aromatase inhibitors (testolactone, anastrozole) and the local application of dihydrotestosterone is also possible.

Note: This dosage information may contain errors. The dosage recommendation in the manufacturer's information is decisive.

8.2 Operative therapy

If the gynecomastia has existed for more than 6 months, fibrosed changes are often found, so that only surgical correction is possible. There are various surgical techniques (e.g. intraareolar or submammary incision, removal of the glandular and fatty tissue, plastic reduction, two-stage tightening surgery).

9 literature

10 sources

  1. ↑ Seibel V et al. The incidence of gynecomastia in dermatological patients, dermatologist 1998; 49: 382-387.