Gynecomastia (translated from the Greek language – the female breast) is a benign increase in the mammary (breast) glands in men. The size of the formations in the chest may be in the range of 1-10 cm, but, as a rule, do not exceed 4 cm in diameter.
There are physiological and pathological gynecomastia.
The first peak of physiological gynecomastia occurs in the neonatal period (60-80%) a few days after birth. This gynecomastia is associated with the circulation of maternal estrogen in the blood, and passes on its own, within 2-4 weeks.
The second peak of the disease occurs in adolescence (12-14 years) and is due to hormonal changes in the body. Adolescent gynecomastia disappears after 6-24 months without treatment.
And the third peak occurs in old age (in men 50-80 years old), it is associated with a decrease in testosterone levels and relative hyperestrogenemia (an increase in the content of female sex hormones).
Also distinguish between false and true gynecomastia.
The false form of the disease develops as a result of the proliferation of adipose tissue (for example, in obesity or overuse of beer).
True gynecomastia is the proliferation of glandular and stromal tissues. It can be affected as one mammary gland – one-sided gynecomastia, and both – bilateral gynecomastia. In adolescents, bilateral form is more common.
The causes of gynecomastia are quite numerous. First of all, true gynecomastia is associated with hormonal imbalance (the predominance of estrogen and / or androgen deficiency):
- congenital hypogonadism (hypoplasia of the testes);
- toxic, radiation or infection of the testes;
- a testicular tumor that produces estrogens;
- adrenal tumor (increased estrogen synthesis);
- dysfunction of the hypothalamus (part of the brain responsible for the formation of hormones);
- genetic diseases (Klinefelter syndrome);
- hyperfunction of the thyroid gland (thyrotoxicosis);
- liver diseases (cirrhosis) in which estrogens are not destroyed;
- choriocarcinoma (a malignant tumor that synthesizes a pregnancy hormone – hCG);
- in male athletes with a sharp cessation of physical exertion;
- malnutrition or hunger;
- renal failure;
- HIV infection (is the cause of hyperprolactinemia).
In addition, gynecomastia can be a side effect when taking the following medications:
- calcium channel blockers (corinfar, verapamil);
- antihypertensive drugs (capoten, Enap);
- antibiotics and antifungal agents (metronidazole, ketoconazole);
- hormonal drugs in the treatment of prostate cancer;
- drugs and alcohol;
- cytostatics (methotrexate);
- antidepressants and tranquilizers (Relanium).
The following clinical picture is characteristic of gynecomastia:
the mammary gland or glands increase in size, mobile elastic formations and tenderness of the mammary glands are determined by palpation,
patients often complain of a feeling of fullness or heaviness in the chest, an increase in the nipples (swelling) and their increased sensitivity,
clear or turbid discharge from nipples.
During gynecomastia there are 3 stages:
- Developing (proliferating) stage – lasts about 4 months. When prescribing treatment, the mammary glands return to their original size.
- Intermediate stage – lasts from 4 to 12 months. At this time, maturation of breast tissue occurs, and the mammary glands practically do not return to their previous size.
- Fibrous stage – characterized by the appearance of mature connective tissue in the mammary gland, and the formation of fatty deposits around the glandular tissue. The fibrous stage is irreversible.
In the diagnosis of gynecomastia ultrasound of the mammary glands, axillary lymph nodes, as well as mammography and needle biopsy are used.
In addition, laboratory diagnostics are carried out, the level of hormones (testosterone, estradiol, thyroid stimulating hormone TSH, prolactin, hCG, luteinizing (LH) and follicle stimulating (FSH) hormone) is determined.
If a testicular tumor is suspected, an ultrasound of the testicles is done, and if an adrenal tumor is suspected, a CT scan is performed.
Often, patients need the advice of a surgeon, urologist, endocrinologist and therapist.
Gynecomastia treatment is carried out by breast oncologists and endocrinologists.
The first step is to establish and eliminate the cause that led to the disease. Depending on the etiology of gynecomastia, the terms of treatment also differ (sometimes they reach several months). When taking drugs, a side effect of which was gynecomastia, it is enough to cancel or reduce the dose.
During the first six months of the development of the disease prefer to watch. If an independent regression of gynecomastia did not occur, conservative hormone therapy is prescribed:
- testosterone (therapy of patients with low levels of this hormone, the elderly);
- Clomiphene is an anti-estrogen used to stimulate ovulation in female infertility;
- tamoxifen – estrogen receptor blocker (with severe disease and severe pain);
- Danazol is a synthetic analogue of testosterone.
Surgical treatment is carried out in patients with suspected malignant process and with a pronounced cosmetic effect.
Mammoplasty involves the removal of breast tissue with the formation of a bed under the nipple in order to avoid zapadeniya.
The most terrible complication of gynecomastia is the malignancy (degeneration into cancer) of the tumor. In addition, emotional disorders and scarring of a long-existing tumor are not excluded.
The prognosis of gynecomastia in newborns and adolescents is favorable (the disease regresses itself). In other cases, the prognosis of the disease depends on the reasons that caused it and also remains favorable during surgical treatment.
Prevention of gynecomastia consists in maintaining a healthy lifestyle, careful selection of drugs that led to the development of the disease, as well as in the prevention of causes that can cause gynecomastia.