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Gynecomastia

Definition, Causes and symptoms, Diagnosis, Treatment, Prognosis

Gyne refers to female, and mastia refers to the breast. Gynecomastia is strictly a male disease and is any growth of the adipose (fatty) and glandular tissue in a male breast. Not all breast growth in men is considered abnormal, just excess growth.

Causes and symptoms

Breast growth is directed exclusively by female hormones—estrogens. Although men have some estrogen in their system, it is usually insufficient to cause much breast enlargement because it is counterbalanced by male hormones—androgens. Upsetting the balance, either by more of one or less of the other, results in the male developing female characteristics, breast growth being foremost.

At birth both male and female infants will have little breast buds from their mother's hormones. These recede until adolescence, when girls always, and boys sometimes, have breast growth. At this time, the boy's breast growth is minimal, often one-sided and temporary.

Extra or altered sex chromosomes can produce inter-sex problems of several kinds. Breast growth along with male genital development is seen in Klinefelter syndrome—the condition of having an extra X (female) chromosome—and a few other chromosomal anomalies. One of the several glands that produce hormones can malfunction for reasons other than chromosomes. Failure of androgen production is as likely to produce gynecomastia as overabundant estrogen production. Testicular failure and castration can also be a cause. Some cancers and some benign tumors can make estrogens. Lung cancer is known to increase estrogens.

If the hormone manufacturing organs are functioning properly, problems can still arise elsewhere. The liver is the principle chemical factory in the body. Other organs like the thyroid and kidneys also effect chemical processes. If any of these organs are diseased, a chemical imbalance can result that alters the manufacturing process. Men with cirrhosis of the liver will often develop gynecomastia from increased production of estrogens.

Finally, drugs can also cause breast enlargement. Estrogens are given to men to treat prostate cancer and a few other diseases. Marijuana and heroin, along with some prescription drugs, have estrogen effects in some men. On the list are methyldopa (for blood pressure), cimetidine (for peptic ulcers), diazepam (Valium), anti-depressants, and spironolactone (a diuretic).

Diagnosis

Carefully feeling the area beneath the nipple of an adolescent boy with breast enlargement will reveal a discreet and sometimes tender lump the size of a fat nickel or quarter. For more serious gynecomastia, the underlying disease will require evaluation, if it is not already well understood.

Treatment

This condition is usually not treated. If it is the result of endocrine disease, hormone manipulations may reduce the effects of the imbalance. There are a number of medical and surgical interventions possible. Radiation of misbehaving organs and cancers is considered an effective treatment.

Prognosis

The progress of gynecomastia is determined by its cause.

Resources

BOOKS

Bennett, J. Claude, and Fred Plum, eds. Cecil Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1996.

Fitzgerald, Paul A. "Endocrinology." In Current Medical Diagnosis and Treatment, 1996. 35th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1995.

Wilson, Jean D. "Endocrine Disorders of the Breast." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

J. Ricker Polsdorfer, MD

KEY TERMS


Androgen—Male sex hormone.

Cirrhosis—Diffuse scarring caused by alcohol or chronic hepatitis often leading to liver failure.

Estrogen—Sex hormone responsible for stimulating female sexual characteristics.

Klinefelter syndrome—A condition in a male characterized by having an extra X (female) chromosome and suffering from infertility and gynecomastia.

Thyroid—A gland in the neck that makes thyroxin. Thyroxin regulates the speed of metabolism.

Additional topics

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