Gynecomastia is an increase in the amount of breast gland tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, both enlargement of the breast can occur unevenly.
It results from the imbalance between the actions of estrogen and androgens at the breast tissue. Breast enlargement can result from the enlargement of the glandular breast tissue that is the chest adipose tissue and skin or either of the combination. Similar in females the estrogen hormone in the males promotes the enlargement of the breast. In addition to directly stimulating the male breast tissue growth, estrogens can indirectly decreases the secreation of the testosterone by suppressing lutenizing hormone secretion resulting in decreased secretion of testosterone by suppressing lutenizing hormone. This leads to deterioration in the testicular testosterone secreation.
Estrogens can increases the blood levels of the protein called as the sex hormone binding protein sex hormone binding globulin which binds to the free testosterone and blocks the action of the testosterone in the enlargement of the male breast tissue. Primary hypogonadism indicating an intrinsic problem with the testes in males leads to decreased testosterone synthesis and also increases the conversion of testosterone to the estradiol which leads to the gynaecomastic appearance. Klinefelter syndrome is a good example becauses it causes the hypogonadism which in turn increases the chances for the gynaecomastia. Central hypogonadism ( indicates the problem with the brain)
Central hypogonadism that is indicating a problem with the brain leads to decreased production and release of leutinizing hormone which leads to decreased production of testosterone and estradiol in the testes.
Individuals who have cirrhosis or chronic liver disease may develop gynaecomastia foe several reasons. Cirrhotics tends to have increased secretion of the androgenic hormone androstenedione from the adrenal glands, increased conversion of this hormone into various types of estrogen and increased levels of SHBg which leads to decreased blood levels of free testosterone. Hyperthyroidism can also lead to the development of the gynaecomastia. Hence resolving the hyperthyroidism might reduces the chances for gynaecomastia.
Swollen breast tissue
Breast enlargement
Discharge from the breast
Swelling
Pain or tenderness on palpation
The diagnosis is based on the following procedure.
Blood tests:
Blood tests are not indicated in those with fatty breast enlargement, physiological pubertal or senile changes as identified drug cause or a clinically apparent cancer.
Renal function
Liver function test
Thyroid function test
Hormone profile:
Estradiol
Testosterone
Prolactin
Beta hCG level
Alpha fetoprotein
Lutenizing hormone
LH and testosterone low – indicates testicular failure
LH and testosterone both low- indicates increase in estrogen.
LH and testosterone both high- androgen resistance or neoplasm secreting gonadotropins.
Chromosomal karyotyping may be needed.
Ultrasonography or mammography of breasts in all doubtful cases or unilateral breast enlargement is needed.
ultrasonography is indicated if there is a raised beta hCG or AFP
Biopsy:
The biopsy is used to indicate and it reveals if any severity arises.
The prognosis is good and the recovery rate id 86% when appropriate treatment is given.
The main mode of prevention is by removing the triggering factors.
