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McCoskey M, Vernon N. Male Reproductive Endocrine Disorders. Prim Care 2024; 51:455-466. [PMID: 39067971 DOI: 10.1016/j.pop.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
The endocrine system intricately regulates male sexual development and health which influences masculinization, sexual libido, muscle mass, bone density, and overall vitality. Disorders in the hypothalamic-pituitary-gonadal axis can lead to hypogonadism, gynecomastia, sexual dysfunction, and infertility. Testosterone replacement therapy can be considered for symptomatic hypogonadism but poses risks for azoospermia and polycythemia, along with uncertain impact on cardiovascular disease. Gynecomastia results from a high estrogen-to-androgen ratio, mostly from either excess estrogen or decreased androgens. Sexual dysfunction is more commonly secondary to psychological or metabolic disorders; consider workups to rule out endocrine etiologies including hypogonadism if indicated.
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Affiliation(s)
- Matthew McCoskey
- Department of Family Medicine, Tidelands Health, 4320 Holmestown Road, Myrtle Beach, SC 29588, USA.
| | - Nicholas Vernon
- Department of Family Medicine, Tidelands Health, 4320 Holmestown Road, Myrtle Beach, SC 29588, USA
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2
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Luo C, Zhang S, Wei C, Guo Y, Zhang Y. The Scar-Hidden Surgery on Gynecomastia: Experiences from a Single-Institutional Large Case Series. Aesthetic Plast Surg 2024:10.1007/s00266-024-04111-0. [PMID: 38886195 DOI: 10.1007/s00266-024-04111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/25/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND To summarize the experiences on the mastoscopic subcutaneous mastectomy for gynecomastia by "nine-step method" based on the "5S" goal and standardize this operation. PATIENTS AND METHODS Between January 1, 2002, and October 31, 2021, a total of 2035 breasts of 1082 male patients with gynecomastia, of which 129 patients with one side, were underwent mastoscopic subcutaneous mastectomy. The follow-up endpoint was 3 months after surgery. RESULTS All patients were successfully completed the operation, and none of them was transferred to open operation. The operation time for unilateral breast was 12-28 min, and the average time was 17.7 ± 6.2 min. The amount of bleeding during unilateral operation was very small, about 5-10 ml. The total drainage volume was 5-50 ml after the operation, and the drainage tube was removed in 3-5 days. The epidermal necrosis occurred in 0.3% nipple. 0.2% chest wall had a little ecchymosis in the supero-medial region of the breast. All patients had the normal feeling of nipples and areola, the smoothing and symmetrical chest wall, and the natural contour. There was no recurrence during the follow-up period. CONCLUSIONS The mastoscopic subcutaneous mastectomy for gynecomastia by "nine-step method" based on the "5S" goal has a short operation time, few surgical complications and good esthetics. It achieves the "5S" goals on the complete removal of glandular tissue (sweeping), small and scar-hidden incision are small (scarless), good symmetry of bilateral chest wall (symmetry), normal chest shape (shape), and smoothing chest wall (smoothing). LEVEL OF EVIDENCE III The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .
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Affiliation(s)
- Chengyu Luo
- Breast surgery, Affiliated Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen road, Chaoyang district, Beijing, 100029, China.
| | - Shuqi Zhang
- Breast surgery, Affiliated Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen road, Chaoyang district, Beijing, 100029, China
| | - Changsheng Wei
- Breast surgery, Affiliated Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen road, Chaoyang district, Beijing, 100029, China
| | - Yang Guo
- Breast surgery, Affiliated Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen road, Chaoyang district, Beijing, 100029, China
| | - Yajing Zhang
- Breast surgery, Affiliated Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen road, Chaoyang district, Beijing, 100029, China
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3
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Metwalley KA, Farghaly HS. Gynecomastia in adolescent males: current understanding of its etiology, pathophysiology, diagnosis, and treatment. Ann Pediatr Endocrinol Metab 2024; 29:75-81. [PMID: 38712491 PMCID: PMC11076233 DOI: 10.6065/apem.2346142.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/23/2023] [Accepted: 10/04/2023] [Indexed: 05/08/2024] Open
Abstract
Gynecomastia (GM) is a common and continuously evolving condition that commonly occurs during adolescence. It is the source of significant embarrassment and psychological stress in adolescent males. GM is characterized by enlargement of the male breast due to the proliferation of glandular ducts and stromal components. The main cause of GM during adolescence is physiological or pubertal GM, which is primarily attributed to an imbalance between estrogen and androgen activity. Physiological GM is typically transient and resolves within several months, although it may take several years to resolve. GM may also be caused by other pathological conditions and could be indicative of an endocrine disease. It is crucial to understand the pathogenesis of GM to distinguish it from normal developmental variants due to pathological causes. The aim of this review is to highlight the significance of GM during adolescence in terms of potential etiologies, clinical and laboratory diagnoses, and current management.
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Affiliation(s)
| | - Hekma Saad Farghaly
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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Blake E, Eugster EA. Routine Endocrinologic Evaluation Is Unnecessary in Adolescent Boys With Gynecomastia. Clin Pediatr (Phila) 2024:99228231225939. [PMID: 38282568 DOI: 10.1177/00099228231225939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Ethan Blake
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Erica A Eugster
- Division of Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
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Chen D, Chen J, Huang Y, Hong C, Li L, Cai B, Hong Z. Comparative analysis of surgical modalities for the gynecomastia treatment: efficiency and aesthetic outcomes. Andrology 2024. [PMID: 38226953 DOI: 10.1111/andr.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/06/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024]
Abstract
This retrospective study rigorously compares the clinical efficacy of three surgical methodologies for treating gynecomastia while providing guidance for future surgical modality selection. We analyzed records of 77 gynecomastia patients treated between January 2015 and October 2022. Patients were categorized into three groups: Group A (subcutaneous gland resection via areola incision), Group B (liposuction combined with single-hole endoscopic gland resection), and Group C (liposuction combined with three-hole endoscopic gland resection). Parameters assessed included patient demographics, intraoperative bleeding, surgical duration, hospitalization duration, costs, postoperative drainage, complications, and patient satisfaction. Group A had significantly shorter operation time and lower cost than Groups B and C (P < 0.05). There were no significant differences in postoperative drainage (P > 0.05). Group A had a higher incidence of subcutaneous fluid complications. All groups achieved 100% overall postoperative efficiency. Group B demonstrated superior outcomes for scarring and patient satisfaction. All three surgical modalities effectively treat gynecomastia. Circumareolar incision subcutaneous gland resection is optimal for mild to moderate cases due to reduced operation time and cost. Liposuction with single-hole endoscopic gland resection and three-hole endoscopic gland resection offers fewer complications and discreet incisions. Notably, the liposuction and single-hole endoscopic approach yielded superior postoperative patient satisfaction, aligning with minimally invasive principles and warranting broad clinical application.
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Affiliation(s)
- Debo Chen
- Department of Breast Surgery, Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Jialin Chen
- Department of Breast Surgery, Longyan Second Hospital, Longyan, Fujian, China
| | - Yiqin Huang
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Chengye Hong
- Department of Breast Surgery, Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Liangqiang Li
- Department of Breast Surgery, Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Bimei Cai
- Department of Health Care, Hui'an Maternal and Child Health Hospital, Quanzhou, Fujian, China
| | - Zhipeng Hong
- Department of Breast Surgery, Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
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Bräuner EV, Uldbjerg C, Lim YH, Beck A, Hueg T, Juul A. Is male gynaecomastia associated with an increased risk of death? A nationwide register-based cohort study. BMJ Open 2024; 14:e076608. [PMID: 38228396 PMCID: PMC10826571 DOI: 10.1136/bmjopen-2023-076608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/26/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVE Recent evidence supports that gynaecomastia may predict long-term morbidity, but evidence on the association with death and causes of death in males with gynaecomastia is lacking. The objective of this work is to estimate the risk of death in men diagnosed with gynaecomastia and evaluate whether this was conditional on underlying aetiologies of gynaecomastia. DESIGN A nationwide register-based cohort study. SETTING Nationwide Danish national health registries. PARTICIPANTS Males were diagnosed with incident gynaecomastia (n=23 429) from 1 January 1995 to 30 June 2021, and each was age and calendar matched to five randomly population-based males without gynaecomastia (n=117 145). INTERVENTIONS Not applicable. PRIMARY AND SECONDARY OUTCOMES Gynaecomastia was distinguished between males without (idiopathic) and males with a known pre-existing risk factor. Cox regression models and Kaplan-Meier analyses estimated associations between gynaecomastia and death (all cause/cause specific). RESULTS We identified a total of 16 253 males with idiopathic gynaecomastia and 7176 with gynaecomastia and a known pre-existing risk factor. Of these, 1093 (6.7%) and 1501 (20.9%) died during follow-up, respectively. We detected a 37% increased risk of all-cause death in males with gynaecomastia in the entire cohort (HR 1.37; 95% CI 1.31 to 1.43). Death risk was highest in males diagnosed with gynaecomastia and a known pre-existing risk factor (HR 1.75; 95% CI 1.64 to 1.86) compared with males with idiopathic gynaecomastia (HR 1.05; 95% CI 0.98 to 1.13). Specific causes of increased death were malignant neoplasms and circulatory, pulmonary and gastrointestinal diseases. Of the latter, an over fivefold risk of death from liver disease was detected (HR 5.05; 95% CI 3.97 to 6.42). CONCLUSIONS Males diagnosed with gynaecomastia are at higher risk of death, observed mainly in males with a known pre-existing risk factor of gynaecomastia. These findings will hopefully stimulate more awareness among healthcare providers to potentially apply interventions that aid in alleviating underlying risk factors in males with this condition.
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Affiliation(s)
- Elvira V Bräuner
- Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet Juliane Marie Centre, Copenhagen, Denmark
| | - Cecilie Uldbjerg
- Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet Juliane Marie Centre, Copenhagen, Denmark
| | - Youn-Hee Lim
- Department of Public Health, University of Copenhagen, Copehnagen, Denmark
| | - Astrid Beck
- Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet Juliane Marie Centre, Copenhagen, Denmark
| | - Trine Hueg
- Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet Juliane Marie Centre, Copenhagen, Denmark
| | - Anders Juul
- Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet Juliane Marie Centre, Copenhagen, Denmark
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Deniz MA, Matsar Öz R. Gynecomastia on Thoracic Computed Tomography. Cureus 2024; 16:e51509. [PMID: 38304650 PMCID: PMC10832307 DOI: 10.7759/cureus.51509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Background and objective Gynecomastia is a benign proliferation of ductal epithelium in the retroareolar region in male patients. The aim of this study was to investigate the frequency of gynecomastia in male patients who underwent thoracic computed tomography (CT) imaging at our clinic, assess possible causes, highlight the imaging characteristics of gynecomastia, and compare our findings with the literature. Materials and methods Male patients over 18 years of age who underwent thoracic CT imaging in our clinic were included in the study. Patients were initially assessed based on age and the presence of gynecomastia. The patients with gynecomastia were evaluated in terms of age, gynecomastia localization (right, left, and bilateral), gynecomastia type (nodular, dentritic, and diffuse), and possible etiology. Results The study included 1500 patients with a mean age of 45.6±21.7 years, and 470 (31.3%) patients had gynecomastia. Gynecomastia was on the right side in 11.3%, on the left side in 11.1%, and bilateral in 77.7% of the patients. Gynecomastia was nodular in 52.1%, dendritic in 35.3%, and diffuse in 17.2% of the patients. The causative factor could not be identified in 44.3% of the patients with gynecomastia. Among cases where the etiology was identified (56.7%), the most common factors were cancer (23.4%), chronic kidney disease (CKD) (13.2%), and chronic hepatitis B (10.7%). Conclusion When evaluating thoracic CT, the breast area, in addition to the lungs, chest wall, and bone structures, should also be evaluated carefully. With the increased use of thoracic CT scans, incidentally detected gynecomastia in patients is also on the rise. Knowing the presence of gynecomastia is very important for the clinician to determine the etiology and treat the underlying disease. Therefore, detecting and reporting gynecomastia on thoracic CT can prevent unnecessary advanced breast imaging methods and play a very important role in treating the underlying etiology.
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Affiliation(s)
| | - Rukan Matsar Öz
- Radiology, Diyarbakır Pediatric Disease Hospital, Diyarbakır, TUR
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8
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Senkoro E, Varadarajan M, Candela C, Gebreselassie A, Antoniadi C, Boffito M. Anastrozole as a therapeutic option for gynecomastia in a person receiving antiretroviral therapy: Case report. Br J Clin Pharmacol 2024; 90:350-353. [PMID: 37917870 DOI: 10.1111/bcp.15951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
A middle-aged Caucasian man living with HIV, clinically stable (viral load <20 copies/mL) on injectable antiretroviral cabotegravir plus rilpivirine every 2 months presented with a 6-month history of bilateral enlargement of the breasts associated with pain. His hormonal profile was normal, and no other underlying cause was identified. He was diagnosed with idiopathic gynecomastia. Tamoxifen is an anti-oestrogen recommended for gynecomastia and has been described in people living with HIV but can potentially induce the activity of cytochrome P450 3A4 (CYP3A4), reducing rilpivirine concentrations, which consequently may cause virological failure and resistance. This is the same for other antiretroviral agents majorly induced by CYP3A4. To date, there have been no reported cases of using anastrozole as a treatment for gynecomastia in people living with HIV or of its co-administration with antiretroviral. We describe the use of an aromatase inhibitor instead of tamoxifen in a person living with HIV, diagnosed with gynecomastia.
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Affiliation(s)
- Elizabeth Senkoro
- Chelsea and Westminster Hospital, London, UK
- Chronic Disease Clinic, Ifakara Health Institute, Morogoro, Tanzania
| | | | - Caterina Candela
- Chelsea and Westminster Hospital, London, UK
- Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Infectious DIseases, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Marta Boffito
- Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
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Yang H, Liang F, Feng Y, Qiu M, Chung K, Zhang Q, Du Z. Single Axillary Incision Reverse Sequence Endoscopic Nipple-Sparing Mastectomy in the Management of Gynecomastia: Short-Term Cosmetic Outcomes, Surgical Safety, and Learning Curve of the Preliminary 156 Consecutive Procedures from a Prospective Cohort Study. Aesthetic Plast Surg 2023:10.1007/s00266-023-03727-y. [PMID: 37957390 DOI: 10.1007/s00266-023-03727-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Currently, a standard, optimal surgical procedure is still lacking for gynecomastia. Despite the development of a variety of surgical interventions, these techniques were often limited to patients with Simon I and II. The present study aimed to introduce a novel technique for all types and grades of gynecomastia, and reported the preliminary results. METHODS Patients who received single axillary incision reverse sequence endoscopic nipple-sparing mastectomy (R-E-NSM) from March 2021 to March 2023 were enrolled at a single institution. The data from 3-month follow-up cut-off were collected prospectively and analyzed to determine the short-term esthetic and safety results of this technique, as well as the learning curve. RESULTS A total of 159 single axillary incision reverse sequence endoscopic nipple-sparing mastectomy procedures were performed in 81 gynecomastia patients. Among these 81 patients, 7 patients (8.6%) were classified as Simon grade I, 29 patients (35.8%) as grade IIa, 24 patients (29.6%) as grade IIb, and 21 patients (25.9%) as grade III. In the patient-reported cosmetic results, the overall satisfaction score was 8.4 ± 1.4. A total of 74.1% of patients were highly satisfied, and 25.9% were satisfied. The overall complication rate was 10.1%, and only 1 patient had a major complication. According to the cumulative sum plot analysis, approximately 12 cases were needed for surgeon B and 11 cases for surgeon C to decrease their operation time significantly. CONCLUSIONS R-E-NSM is safe and effective for all Simon grade gynecomastia patients, with excellent cosmetic results and a short learning curve. However, a long-term follow-up assessment is still needed. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Huanzuo Yang
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Faqing Liang
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Yu Feng
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, The Fourth People's Hospital of Sichuan Province, 12 Chengshoudong Street, Jinjiang District, Chengdu, 610016, China
| | - Mengxue Qiu
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Kawun Chung
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Qing Zhang
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Zhenggui Du
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
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Pozza C, Tenuta M, Sesti F, Bertolotto M, Huang DY, Sidhu PS, Maggi M, Isidori AM, Lotti F. Multiparametric Ultrasound for Diagnosing Testicular Lesions: Everything You Need to Know in Daily Clinical Practice. Cancers (Basel) 2023; 15:5332. [PMID: 38001591 PMCID: PMC10670367 DOI: 10.3390/cancers15225332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Ultrasonography (US) represents the gold standard imaging method for the assessment of testicular lesions (TL). The gray-scale (GSUS) and color-Doppler (CDUS) ultrasound examination allow sonographers to investigate the size, margins, echotexture, and vascular features of TLs with the aim to differentiate benign from malignant lesions. Recently, the use of contrast-enhanced US (CEUS) and sonoelastography (SE) has led to further improvements in the differential diagnosis of TL. Although GSUS and CDUS are often sufficient to suggest the benign or malignant nature of the TL, CEUS can be decisive in the differential diagnosis of unclear findings, while SE can help to strengthen the diagnosis. The contemporary combination of GSUS, CDUS, CEUS, and SE has led to a new diagnostic paradigm named multiparametric US (mp-US), which is able to provide a more detailed characterization of TLs than single techniques alone. This narrative and pictorial review aimed to describe the mp-US appearance of several TLs. METHODS An extensive Medline search was performed to identify studies in the English language focusing on the mp-US evaluation of TLs. RESULTS A practical mp-US "identity card" and iconographic characterization of several benign and malignant TLs is provided herein. CONCLUSIONS The mp-US characterization of TL reported herein can be useful in daily clinical practice.
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Affiliation(s)
- Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Marta Tenuta
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Michele Bertolotto
- Department of Radiology, Ospedale Di Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Dean Y. Huang
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Paul S. Sidhu
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy;
| | - Andrea M. Isidori
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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11
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Xia Z, Ding N, Kang Y, Guan A, Wen J, Ma X, Liu Z, Yu N, Kong L, Zhu L. Is Breast Magnetic Resonance Imaging Superior to Sonography in Gynecomastia Evaluation and Surgery Planning. Aesthetic Plast Surg 2023; 47:1759-1770. [PMID: 37500904 DOI: 10.1007/s00266-023-03506-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/30/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Data on the value of magnetic resonance imaging (MRI) in the preoperative evaluation and surgery planning of gynecomastia are limited. The purpose of this study is to reveal MRI features and categories of gynecomastia and compare surgical outcomes following MRI and sonography as well as their diagnostic accuracy. METHODS The area of the gland and the whole breast on the transverse plane via nipple of MRI were measured to calculate the ratio between them. Areola, mass and branch patterns were categorized to represent three different gynecomastia type on MRI. 183 patients were included, with 38 in MRI group and 145 in sonography group. Diagnostic accuracy was assessed by the level of agreement between preoperative imaging findings and intraoperative observations. Surgical data, patients' satisfaction and complications were compared between the two groups. RESULTS MRI in 75 gynecomastic breasts demonstrated the average ratio of the gland to the whole breast was 10.6%±13.3%. The most common MRI categories were branch patterns (45.3%). The diagnostic concordance rate of MRI was higher than sonography (100% vs. 86.8%, p = 0.001). Among those junior surgeons, the length of surgery was reduced in MRI group (100 min vs. 115 min, p = 0.048). There was no difference in terms of patient's satisfaction and complication rate between MRI and sonography. CONCLUSION MRI was superior to sonography in diagnostic accuracy to assess the tissue components of gynecomastia and provided informative guidance especially for junior surgeons. Surgical outcomes were comparable regardless of the use of MRI or sonography for evaluation. LEVEL OF EVIDENCE IV IThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Zenan Xia
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Ning Ding
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yuanbo Kang
- Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Santiao 9#, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Ai Guan
- Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Santiao 9#, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Junxian Wen
- Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Santiao 9#, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xuda Ma
- Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Santiao 9#, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zhifei Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Lingyan Kong
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Lin Zhu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Dongcheng District, Beijing, 100730, People's Republic of China.
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Orlova IA, Sorokin ED, Pavlova ZS, Plisyuk AG, Kamalov AA. Linking Cardiovascular Risk With Estradiol Level in Men. KARDIOLOGIIA 2023; 63:14-19. [PMID: 37815135 DOI: 10.18087/cardio.2023.9.n2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/17/2023] [Indexed: 10/11/2023]
Abstract
Aim To study the relationship between the cardiovascular risk and the level of estradiol in men of young and middle age. The main group included 71 patients with newly diagnosed hyperestrogenia (HE) (serum estradiol >41.2 pg/ ml). Using pseudorandomization, 68 men with normal estradiol level and age- and body weight index (BWI)-matched with the main group were included into the control group. Anthropometric data, bioimpedance variables, blood pressure (BP), and concentrations of estradiol, testosterone, glucose, and total cholesterol were analyzed in both groups.Results Patients of the main and control groups did not differ in age, BWI, and smoking status. Testosterone concentration was 10.18 nmol/l in the HE group and 12.18 nmol /l in the control group (p=0.006). Systolic BP was 142.0 mm Hg in the HE group and 135.2 mm Hg in the control group (p=0.011); diastolic BP was 90.3 mm Hg in the HE group and 86.2 mm Hg in the control group (p=0.008). Total cholesterol was 5.87 mmol/l in the HE group and 5.33 mmol/l in the control group (p=0.023). Blood glucose did not differ between the groups. The presence of HE in men 2.11 times (р=0.038) increased the probability of arterial hypertension. The intergroup difference by the SCORE scale did not reach statistical significance (р=0.172). BWI, waist and hip circumferences, and bioimpedance body composition parameters did not differ between the groups.Conclusion In the studied cohort of young and middle-aged men, HE was an independent predictor for the presence of arterial hypertension. There were no significant intergroup differences in the total risk of cardiovascular diseases calculated with the SCORE scale.
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Affiliation(s)
- Ia A Orlova
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow
| | - E D Sorokin
- School of Fundamental Medicine, Lomonosov Moscow State University, Moscow
| | - Z Sh Pavlova
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow
| | - A G Plisyuk
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow
| | - A A Kamalov
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow
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Esposito C, Lepore B, Cerulo M, Del Conte F, Coppola V, Esposito G, Carulli R, Carraturo F, Escolino M. Applications of indocyanine green (ICG) fluorescence technology in open surgery: preliminary experience in pediatric surgery. Front Surg 2023; 10:1238487. [PMID: 37655191 PMCID: PMC10467265 DOI: 10.3389/fsurg.2023.1238487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
Background Indocyanine green fluorescence technology (ICG) in pediatric minimally invasive surgery has undergone an important improvement in the last 5 years. However, its use in open surgery is still limited. In this paper, we aim to report our preliminary experience with Rubina® lens ICG fluorescence technology in combination with the IMAGE1 S™ system from KARL STORZ in open excision of masses in children. Methods The records of 18 patients undergoing open surgery for head, neck and thorax masses between September and November 2022 were retrospectively reviewed. Rubina® lens ICG fluorescence technology system was used in all the cases. In 10 cases we adopted the holding arm system and in 8 cases the hand-held technique. Data about patients' demographics, surgery and outcomes were collected and analyzed through the following criteria: mass localization, intraoperative time (min), ICG administration (ml), intraoperative complications, postoperative complications. Results A total of 18 patients were operated: 4 thyroglossal duct cysts, 3 supraorbital cysts, 2 neck masses, 2 pre-auricular and 2 scalp cysts, 2 gynecomastias, 2 lymphangiomas, 1 nose mass. In all the cases, intralesional injection of 0.5-1 ml of ICG solution was performed peri-operatively. Mean operative time was 58.4 min (35-134 min). Postoperative complications included seroma formation in 2 cases. Surgical pathology reports confirmed complete mass excision in all the cases. Conclusion Based on our preliminary experience, ICG fluorescence guided surgery using Rubina® lens system was very helpful also in open surgery procedures. Rubina® lens system permits to have a very low complication rate, a time-saving surgery, a real time reliability of anatomic structures and an excellent clinical safety. In our experience, holding arm system seems more comfortable than hand-held system. However, further cases need to be performed to evaluate the exact role and to identify new indications of this technique in open pediatric surgical procedures.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples “Federico II”, Naples, Italy
| | - Benedetta Lepore
- Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples “Federico II”, Naples, Italy
| | - Mariapina Cerulo
- Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples “Federico II”, Naples, Italy
| | - Fulvia Del Conte
- Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples “Federico II”, Naples, Italy
| | - Vincenzo Coppola
- Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples “Federico II”, Naples, Italy
| | - Giovanni Esposito
- CEINGE Advanced Biotechnologies Center Franco Salvatore scarl, Naples, Italy
| | - Roberto Carulli
- Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples “Federico II”, Naples, Italy
| | - Francesca Carraturo
- Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples “Federico II”, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples “Federico II”, Naples, Italy
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Beniwal M, Singh K, Singh P, Sharma A, Beniwal S. The Burden of Anabolic Androgenic Steroid-Induced Gynecomastia. Indian J Plast Surg 2023; 56:338-343. [PMID: 37705825 PMCID: PMC10497340 DOI: 10.1055/s-0043-1771293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Introduction Gynecomastia is benign proliferation of male breast tissue that can be idiopathic or secondary to hormonal imbalance. Consumption of steroids plays a major role in the development of gynecomastia. The increased consumption of anabolic androgenic steroid (AAS) in youngsters to boost the physical strength and improve appearance is associated with increased prevalence of gynecomastia. True estimation of AAS-associated gynecomastia is difficult to calculate and prone to underestimation because of low social acceptance. Accurate estimation is required to assess future healthcare, for prevention and to give appropriate treatment. Aims and Objectives The aim of this study was to calculate the steroid consumption in gynecomastia patients accurately so that appropriate treatment can be given and their response to treatment could be analysed. Methods This is a prospective study done in a tertiary care hospital from June 2019 to June 2022. All the gynecomastia patients treated during this period in Burns & Plastic Surgery Department of PGIMS Rohtak were included in the study. Patient's detailed history was recorded and also after 3 months of surgery patients were again enquired about their history to record any change. Results Real prevalence of AAS-associated gynecomastia (39.19%) was much higher than that recorded in preoperative period (4.05%). Also, AAS users were having higher body mass index and a greater proportion of patients were bodybuilders. Conclusion Patients with high body mass index, athletic body, and history of recent weight gain should raise the suspicion of anabolic steroid intake. Surgery is not always indicated in AAS-associated gynecomastia. If gynecomastia persisted, surgery necessitates and it involves meticulous intraoperative hemostasis and careful glandular excision to minimize recurrence and achieve low complication rates.
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Affiliation(s)
- Meenu Beniwal
- Department of Burns & Plastic Surgery, PGIMS Rohtak, Haryana, India
| | - Kuldeep Singh
- Department of Burns & Plastic Surgery, PGIMS Rohtak, Haryana, India
| | | | - Abhishek Sharma
- Department of Burns & Plastic Surgery, PGIMS Rohtak, Haryana, India
| | - Sonu Beniwal
- Department of Ophthalmology, Medanta - The Medicity, Gurugram, Haryana, India
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Sabancı E, Pehlivantürk-Kızılkan M, Akgül S, Derman O, Kanbur N. Tamoxifen Treatment for Pubertal Gynecomastia: When to Start and How Long to Continue. Breast Care (Basel) 2023; 18:249-255. [PMID: 37900549 PMCID: PMC10601691 DOI: 10.1159/000530408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/24/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Pubertal gynecomastia is a common clinical condition among male adolescents, and in most cases, it regresses spontaneously. However, tamoxifen treatment is recommended in selected cases. We aimed to evaluate the indications, safety, and efficacy of tamoxifen treatment in adolescents with pubertal gynecomastia. Methods The data of 83 adolescents with pubertal gynecomastia who were treated with tamoxifen between 2006 and 2018 were evaluated retrospectively. The clinical and laboratory data, initial complaint, tamoxifen treatment indication, duration, and dose were recorded along with the treatment outcome. Results The gynecomastia disc diameter's monthly reduction rate was significantly higher in adolescents with an initial disc diameter ≥3 cm. The significant reduction of the disc started after the fourth month of tamoxifen treatment and continued to significantly reduce, extending to the sixth month. Conclusion Tamoxifen treatment in pubertal gynecomastia was found to be effective and safe. One of the current indications for tamoxifen treatment is having a disc size ≥4 cm, and the recommended treatment duration is 4-6 months. However, this study suggests that treatment should be continued for at least 6 months to achieve the optimal effect. In addition, we recommend that the disc diameter threshold for starting tamoxifen needs to be ≥3 cm.
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Affiliation(s)
- Elif Sabancı
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Melis Pehlivantürk-Kızılkan
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sinem Akgül
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Orhan Derman
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nuray Kanbur
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Uldbjerg CS, Lim YH, Bräuner EV, Juul A. Increased Morbidity in Males Diagnosed With Gynecomastia: A Nationwide Register-based Cohort Study. J Clin Endocrinol Metab 2023; 108:e380-e387. [PMID: 36718997 PMCID: PMC10271232 DOI: 10.1210/clinem/dgad048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/15/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
CONTEXT Evidence on the long-term and general health of males with gynecomastia is lacking. OBJECTIVES To assess health before and following a diagnosis of gynecomastia. METHODS A register-based cohort study of 140 574 males, of which 23 429 were diagnosed with incident gynecomastia and age- and calendar-matched (1:5) to 117 145 males without gynecomastia from the background population. Males with gynecomastia were stratified into males without (idiopathic) or with a known preexisting risk factor (disease/medication). Cox and logistic regression models investigated associations of disease risk according to International Classification of Diseases 10th revision sections following and before gynecomastia diagnosis. RESULTS A total of 16 253 (69.4%) males in the cohort were identified with idiopathic gynecomastia. These males had a statistically significant higher risk of future disease across all included disease chapters (hazard ratio [HR], 1.19-1.89), with endocrine diseases representing the greatest disease risk (HR, 1.89; 95% CI, 1.76-2.03). The highest subchapter disease risk was observed for disorders of the endocrine glands (odds ratio [OR], 7.27; 95% CI, 6.19-8.54). Similarly, the ORs of comorbidities were higher across all included disease sections (OR, 1.05-1.51), except for psychiatric disease (OR, 0.72; 95% CI, 0.68-0.78), with the highest association with musculoskeletal/connective tissue (OR, 1.51; 95% CI, 1.46-1.57) and circulatory (OR, 1.36; 95% CI, 1.29-1.43) diseases. CONCLUSIONS The presence of idiopathic gynecomastia is an important first clinical symptom of an underlying disease and a significant predictor of future disease risk. These findings should stimulate more awareness among health care providers to increase identification of gynecomastia and its causes in males.
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Affiliation(s)
- Cecilie S Uldbjerg
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen 1353, Denmark
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Elvira V Bräuner
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2100, Denmark
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17
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Corona G, Cucinotta D, Di Lorenzo G, Ferlin A, Giagulli VA, Gnessi L, Isidori AM, Maiorino MI, Miserendino P, Murrone A, Pivonello R, Rochira V, Sangiorgi GM, Stagno G, Foresta C, Lenzi A, Maggi M, Jannini EA. The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction. J Endocrinol Invest 2023; 46:1241-1274. [PMID: 36698034 PMCID: PMC9876440 DOI: 10.1007/s40618-023-02015-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized. METHODS The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS Several evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed. CONCLUSIONS These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
| | - D Cucinotta
- Chair of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G Di Lorenzo
- Section of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - A Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - V A Giagulli
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", Bari, Italy
- Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - L Gnessi
- Section of Food Science, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Section of Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M I Maiorino
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - P Miserendino
- Diabetology and Endocrinology Unit, ASP #, Caltanissetta, Italy
| | - A Murrone
- Cardiology Unit, Città di Castello and Gubbio-GualdoTadino Hospitals, Azienda Usl Umbria 1, Gubbio, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile, Università Federico II di Napoli, Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - V Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G M Sangiorgi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - G Stagno
- Diabetology Unit, ASP Reggio Calabria, Reggio Calabria, Italy
| | - C Foresta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - A Lenzi
- Section of Food Science, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - E A Jannini
- Chair of Endocrinology and Sexual Medicine (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, E Tower South Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy.
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Lashin R, Youssef RA, Elshahat A, Mohamed EN. Postoperative Psychological Impact on Teenagers after Gynecomastia Correction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5094. [PMID: 37361507 PMCID: PMC10287129 DOI: 10.1097/gox.0000000000005094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/05/2023] [Indexed: 06/28/2023]
Abstract
Gynecomastia is common among teenagers. Most published research focused on how surgery is effective in enhancing the aesthetic appearance of the breast. Limited information is already known about the psychosocial benefits of surgical interventions. This study explores and assesses the surgical, cosmetic, and psychological outcome of gynecomastia correction in teenagers. Methods This prospective study included 20 teenagers with Simon grade IIA gynecomastia. The assessment included complications, patients' satisfaction, Manchester Scar Scale, and Li et al questionnaire at 12 months postoperative. Rosenberg Self-Esteem Scale, 36-Item Short Form Survey (SF-36) for quality of life, and school achievement level were evaluated 1 month preoperative and 12 months postoperative. Statistical analysis was done. Results Patients were aged 13-19 years old. The follow-up period was 12 ± 36 months. Postoperative complications included seroma formation (n = 1) and mild asymmetry (n = 3). Results were "uniformly good to excellent" on a satisfaction scale. The Manchester Scar Scale shows the lowest score, which denotes the highest outcomes. The Li et al questionnaire showed a positive overall change. Comparing Rosenberg Scale scores pre- and postoperatively revealed higher scores postoperatively, which indicate higher self esteem. Comparing SF-36 pre- and postoperatively showed a significant increase in postoperative quality of life. Comparing school achievement pre- and postoperatively showed marked improvement postoperatively. Results were highly statistically significant. Conclusions Surgical treatment of teenage gynecomastia is beneficial for different psychosocial domains. Pull-through of the mammary gland combined with liposuction provides satisfactory cosmetic results. Patients who underwent surgery reported a significant improvement in psychosocial load, better school achievement, higher quality of life, and better self-esteem.
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Affiliation(s)
- Riham Lashin
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ramy A. Youssef
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Elshahat
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman Nagy Mohamed
- From the Plastic, Burn, and Maxillofacial Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Shang F, Zhao Z, Li Z, Liu B. The combination of endoscopic subcutaneous mastectomy and liposuction (Liu and Shang's 2-hole 7-step method) as the treatment of gynecomastia. Surgery 2023:S0039-6060(23)00198-8. [PMID: 37198036 DOI: 10.1016/j.surg.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/26/2023] [Accepted: 04/09/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Most patients suffering from gynecomastia require treatment to maintain a smooth subcutaneous tissue contour, remove loose skin, and leave a suitable nipple-areolar complex with minimal scarring; hence, surgery has become the prime choice to treat gynecomastia. Based on our experience, Liu and Shang's 2-hole 7-step method works well for these patients. METHODS From November 2021 to November 2022, a total of 101 gynecomastia patients featuring various Simon grades were included in this study. The patients' basic condition and surgical procedure were recorded in detail. A score of 1 to 5 was given for 6 main aesthetic aspects. RESULTS With Liu and Shang's 2-hole 7-step method, the operations were successfully completed in all 101 patients. Six patients had Simon grade I, 21 grade IIA, 56 grade IIB, and 18 grade III. The average surgery time was 86.54 (range = 46-144) minutes. The average intraoperative blood loss was 22.7 (range = 10 ∼ 75) mL. The average postoperative drainage time was 2.35 (range = 1-4) days, the drainage volume was 83.35 (range = 13∼240) mL, and the drainage mainly occurred on the first postoperative day. The scores on all 6 aesthetic aspects were >4 points, which fully affirmed the aesthetic effect of this method. CONCLUSION Liu and Shang's 2-hole 7-step method is safe and feasible for treating gynecomastia and has been fully affirmed for its efficacy and cosmetic effect. It can be the main option for minimally invasive surgery to treat gynecomastia.
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Affiliation(s)
- Fangjian Shang
- Department of General Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Zengren Zhao
- Department of General Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Zhongxin Li
- Department of General Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Bo Liu
- Department of General Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, P.R. China.
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Reyes AP, León NY, Frost ER, Harley VR. Genetic control of typical and atypical sex development. Nat Rev Urol 2023:10.1038/s41585-023-00754-x. [PMID: 37020056 DOI: 10.1038/s41585-023-00754-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/07/2023]
Abstract
Sex development relies on the sex-specific action of gene networks to differentiate the bipotential gonads of the growing fetus into testis or ovaries, followed by the differentiation of internal and external genitalia depending on the presence or absence of hormones. Differences in sex development (DSD) arise from congenital alterations during any of these processes, and are classified depending on sex chromosomal constitution as sex chromosome DSD, 46,XY DSD or 46,XX DSD. Understanding the genetics and embryology of typical and atypical sex development is essential for diagnosing, treating and managing DSD. Advances have been made in understanding the genetic causes of DSD over the past 10 years, especially for 46,XY DSD. Additional information is required to better understand ovarian and female development and to identify further genetic causes of 46,XX DSD, besides congenital adrenal hyperplasia. Ongoing research is focused on the discovery of further genes related to typical and atypical sex development and, therefore, on improving diagnosis of DSD.
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Affiliation(s)
- Alejandra P Reyes
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Genetics Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Nayla Y León
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Emily R Frost
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Vincent R Harley
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
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21
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He W, Wei W, Zhang Q, Lv R, Qu S, Huang X, Ma J, Zhang P, Zhai H, Wang N. A retrospective cohort study of tamoxifen versus surgical treatment for ER-positive gynecomastia. BMC Endocr Disord 2023; 23:62. [PMID: 36915127 PMCID: PMC10010038 DOI: 10.1186/s12902-023-01310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Gynecomastia is a common condition in clinical practice. The present study aimed to review the clinical data of ER-positive gynecomastia patients treated by tamoxifen (TAM) versus surgery and discussed the clinical effects of the two treatment strategies. METHOD We retrospectively collected the clinical indicators of patients with unilateral or bilateral gynecomastia who received treatment at our hospital between April 2018 and December 2021. Depending on the treatment received, the patients were divided into TAM and surgery groups. RESULT A total of 170 patients were recruited, including 91 patients in TAM group and 79 patients in surgery group. The age of the patients differed significantly between the TAM and surgery groups (P < 0.01). The estrogen level was closer in patients with stable and progressive disease, but significantly different in patients of glandular shrinkage in TAM group (P < 0.01). The proportion of patients achieving stable disease was higher among those with clinical grade 1-2. Among patients classified as clinical grade 3, the proportion of patients achieving glandular shrinkage of the breast was higher after TAM treatment (P < 0.05). The age and length of hospital stay were significantly different in patients undergoing open surgery than minimally invasive rotary cutting surgery and mammoscopic-assisted glandular resection (P < 0.01). Patients had significantly different complications including mild postoperative pain, hematoma, nipple necrosis, nipple paresthesias and effusions among the surgery subgroups (all P < 0.05). The estrogen level and the type of surgery were significantly different between the surgical recurrence and non-recurrence subgroups (P < 0.05). The difference in the thickness of glandular tissues upon the color Doppler ultrasound also reached a statistical significance between the two groups (P = 0.050). An elevated estrogen level was a factor leading to TAM failure. Among surgical patients, the thickness of glandular tissues, estrogen level, and type of surgery performed were risk factors for postoperative recurrence (all P < 0.05). CONCLUSION Both treatment strategies can effectively treat gynecomastia, but different treatment methods can benefit different patients. TAM treatment is more beneficial than surgery for patients who cannot tolerate surgery, have a low estrogen level, and are clinical grade 1-2. Surgery treatment is better than TAM for patients of clinical grade 3. Different surgery options may lead to different complications. Patients with a greater glandular tissue thickness and a higher estrogen level were shown to have a higher risk of recurrence.
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Affiliation(s)
- Weili He
- Department of Breast Surgery, the First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Weidong Wei
- Department of Breast Surgery, Sun Yat-sen University Cancer Center, 510630, Guangzhou, China
| | - Qing Zhang
- Department of Breast Surgery, the First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Rongzhao Lv
- Department of Breast Surgery, the First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Shaohua Qu
- Department of Breast Surgery, the First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Xin Huang
- Department of Breast Surgery, the First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Juan Ma
- Department of Laboratory, the First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Ping Zhang
- Department of Ultrasonography, the First Affiliated Hospital of Jinan University, 510630, Guangzhou, China
| | - Hening Zhai
- Department of Digestive Endoscopy c Center, the First/Fifth Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Tianhe District, 510630, Guangzhou, China.
| | - Ningxia Wang
- Department of Breast Surgery, the First Affiliated Hospital of Jinan University, 510630, Guangzhou, China.
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22
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Amer M, Vaccalluzzo L, Vena W, Mazziotti G, Morenghi E, Pizzocaro A. Oncological diseases in Klinefelter Syndrome: an overview. Minerva Endocrinol (Torino) 2023; 48:106-114. [PMID: 34014064 DOI: 10.23736/s2724-6507.21.03440-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Epidemiological studies have highlighted a higher incidence of morbidity and mortality among individuals with Klinefelter's Syndrome (KS), however, the relative impact of oncological diseases on KS subjects is still uncertain. While some malignancies (e.g., hematological and lung cancers) may show an increased prevalence in the KS population, only a few rare tumors (i.e., extragonadal germ cell tumors [GCTs] and male breast cancer [MBC]) seem to follow this trend. Additionally, hormonal and genetic determinants may be involved in the pathogenesis of neoplasia in KS, even if subjects affected by this syndrome generally show lower incidence of prostate cancer along with lower disease-specific mortality despite testosterone replacement therapy (TRT). This review deals with the pathophysiological and clinical aspects of neoplastic diseases occurring in KS.
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Affiliation(s)
- Myriam Amer
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Liborio Vaccalluzzo
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Walter Vena
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy -
| | - Gherardo Mazziotti
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Alessandro Pizzocaro
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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23
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Clinical utility of laboratory developed mass spectrometry assays for steroid hormone testing. J Mass Spectrom Adv Clin Lab 2023; 28:13-19. [PMID: 36756146 PMCID: PMC9900367 DOI: 10.1016/j.jmsacl.2023.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023] Open
Key Words
- ART, assisted reproductive technology
- CAP, College of American Pathologists
- CDC, Centers for Disease Control and Prevention
- CRP, C-reactive protein
- Endocrinology
- FDA, US Food and Drug Administration
- GC–MS, gas chromatography-mass spectrometry
- Immunoassay
- LC-MS/MS
- LC-MS/MS, liquid chromatography-tandem mass spectrometry
- Mass spectrometry
- NIST, National Institutes of Science and Technology
- RIA, radioimmunoassay
- RMP, Reference Measurement Procedure
- SRM, Standard Reference Material
- Sensitivity
- Specificity
- Steroid hormones
- VALID, Verifying Accurate Leading-edge IVCT Development Act of 2022
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24
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Ishfaq M, Aamir M, Ahmad F, M Mebed A, Elshahat S. Machine Learning-Assisted Prediction of the Biological Activity of Aromatase Inhibitors and Data Mining to Explore Similar Compounds. ACS OMEGA 2022; 7:48139-48149. [PMID: 36591131 PMCID: PMC9798507 DOI: 10.1021/acsomega.2c06174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Designing molecules for drugs has been a hot topic for many decades. However, it is hard and expensive to find a new molecule. Thus, the cost of the final drug is also increased. Machine learning can provide the fastest way to predict the biological activity of druglike molecules. In the present work, machine learning models are trained for the prediction of the biological activity of aromatase inhibitors. Data was collected from the literature. Molecular descriptors are calculated to be used as independent features for model training. The results showed that the R 2 values for linear regression, random forest regression, gradient boosting regression, and bagging regression are 0.58, 0.84, 0.77, and 0.80, respectively. Using these models, it is possible to predict the activity of new molecules in a short period of time and at a reasonable cost. Furthermore, Tanimoto similarity is used for similarity analysis, as well as a chemical database is mined to search for similar molecules. Nonetheless, this study provides a framework for repurposing other effective drug molecules to prevent cancer.
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Affiliation(s)
- Muhammad Ishfaq
- College
of Computer Science, Huanggang Normal University, Huanggang 438000, China
| | - Muhammad Aamir
- College
of Computer Science, Huanggang Normal University, Huanggang 438000, China
| | - Farooq Ahmad
- Department
of Biomedical Engineering, College of Engineering and Applied Sciences,
School of Chemistry and Chemical Engineering, Chemistry and Biomedicine
Innovation Center (ChemBIC), Nanjing University, Nanjing 210093, China
| | - Abdelazim M Mebed
- Physics
Department, Faculty of Science, Assiut University, Assiut 71516, Egypt
- Department
of Physics, College of Science, Jouf University, P.O. Box 2014, Al-Jouf, Sakaka 72388, Saudi Arabia
| | - Sayed Elshahat
- Physics
Department, Faculty of Science, Assiut University, Assiut 71516, Egypt
- Beijing
Key Lab of Nanophotonics and Ultrafine Optoelectronic Systems, Center
for Micro-Nanotechnology; Key Lab of Advanced Optoelectronic Quantum
Design and Measurement, Ministry of Education, School of Physics, Beijing Institute of Technology, Beijing 100081, P. R. China
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25
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Karamchandani MM, De La Cruz Ku G, Sokol BL, Chatterjee A, Homsy C. Management of Gynecomastia and Male Benign Diseases. Surg Clin North Am 2022; 102:989-1005. [DOI: 10.1016/j.suc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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Daniels J, Brickstock A, Charlton R. Gynaecomastia. BMJ 2022; 379:e069771. [PMID: 36265883 DOI: 10.1136/bmj-2021-069771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Pasquali D, Chiodini P, Simeon V, Ferlin A, Vignozzi L, Corona G, Lanfranco F, Rochira V, Calogero AE, Bonomi M, Pivonello R, Balercia G, Pizzocaro A, Giagulli VA, Salacone P, Aversa A, Accardo G, Maggi M, Lenzi A, Isidori A, Foresta C, Jannini EA, Garolla A. First baseline data of the Klinefelter ItaliaN Group (KING) cohort: clinical features of adult with Klinefelter syndrome in Italy. J Endocrinol Invest 2022; 45:1769-1776. [PMID: 35608733 PMCID: PMC9360143 DOI: 10.1007/s40618-022-01816-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Klinefelter syndrome (KS) is frustratingly under-diagnosed. KS have a broad spectrum of clinical features, making it difficult to identify. OBJECTIVE: We describe KS clinical presentation in a large Italian cohort. DESIGN This is the first observational cohort study within a national network, the Klinefelter ItaliaN Group (KING). Primary outcomes were to describe the basic clinical features and the actual phenotype of KS in Italy. Secondary outcomes were to determine age at diagnosis and geographical distribution. METHODS We performed a basic phenotyping and evaluation of the hormonal values of 609 adult KS patients. RESULTS Mean age at diagnosis was 37.4 ± 13.4 years. The overall mean testicular size was 3 ml, and 2.5 ml in both testes in untreated KS group. BMI was 26.6 ± 5.8 kg/m2, and 25.5% of KS had metabolic syndrome (MetS). LH and FSH were increased, and mean total testosterone were 350 ± 9.1 ng/dl. A descriptive analysis showed that 329 KS patients were evaluated in Northern Italy, 76 in Central and 204 in Southern Italy. Analysis of variance demonstrated significant statistical differences (p < 0001) between the age at diagnosis of the three geographical groups. Compared with the expected number among male patients matched for age in Italy, only 16% of KS patients received a diagnosis. CONCLUSIONS These data are the results of the only national database available that collects the clinical and hormonal data of the KS patients, currently referred at the KING centers. In Italy the typical KS patient is overweight, with small testes, and elevated LH and FSH. Only 25.5% of them are diagnosed with MetS. Early detection and timely treatment are mandatory.
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Affiliation(s)
- D Pasquali
- Endocrinology Unit, Department of Advanced Medical And Surgical Sciences, University of Campania "L. Vanvitelli", 80138, Napleszz, Italy.
| | - P Chiodini
- Endocrinology Unit, Department of Advanced Medical And Surgical Sciences, University of Campania "L. Vanvitelli", 80138, Napleszz, Italy
| | - V Simeon
- Endocrinology Unit, Department of Advanced Medical And Surgical Sciences, University of Campania "L. Vanvitelli", 80138, Napleszz, Italy
| | - A Ferlin
- University of Padua, Padua, Italy
| | | | - G Corona
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | | | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - M Bonomi
- Dept of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Dept. Of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | | | | | - A Pizzocaro
- IRCCS, Istituto Clinico Humanitas, Rozzano-Milan, Italy
| | - V A Giagulli
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari Aldo Moro, Bari, Italy
- Outpatients Clinic of Endocrinology and Metabolic Disease, Conversano Hospital, Bari, Italy
| | - P Salacone
- Santa Maria Goretti Hospital, Latina, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy
| | | | - M Maggi
- University of Firenze, Firenze, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome-Policlinico Umberto Hospital, Rome, Italy
| | | | | | - E A Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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28
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Makdissi FBA, Santos SS, Bitencourt A, Campos FAB. An introduction to male breast cancer for urologists: epidemiology, diagnosis, principles of treatment, and special situations. Int Braz J Urol 2022; 48:760-770. [PMID: 35373955 PMCID: PMC9388172 DOI: 10.1590/s1677-5538.ibju.2021.0828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 11/22/2022] Open
Abstract
Breast cancer (BC) is mainly considered a disease in women, but male BC (MaBC) accounts for approximately 1.0% of BC diagnoses and 0.5% of malignant neoplasms in the western population. The stigmatization of MaBC, the fact that men are less likely to undergo regular health screenings, and the limited knowledge of health professionals about MaBC contribute to men being diagnosed at more advanced stages. The aim of this article is to increase the visibility of MaBC among urologists, who have more contact with male patients. This review highlights key points about the disease, the risk factors associated with MaBC, and the options for treatment. Obesity and increased population longevity are among the important risk factors for MaBC, but published studies have identified family history as extremely relevant in these patients and associated with a high penetrance at any age. There is currently no screening for MaBC in the general population, but the possibility of screening in men at high risk for developing BC can be considered. The treatment of MaBC is multidisciplinary, and, because of its rarity, there are no robust clinical studies evaluating the role of systemic therapies in the management of both localized and metastatic disease. Therefore, in current clinical practice, treatment strategies for men with breast cancer are extrapolated from information arising from studies in female patients.
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Affiliation(s)
| | - Silvana S Santos
- Centro de Referência da Mama, AC Camargo Cancer Center, São Paulo, SP, Brasil
| | - Almir Bitencourt
- Centro de Referência da Mama, AC Camargo Cancer Center, São Paulo, SP, Brasil
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29
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Essafi MA, Elazizi L, Aynaou H, Salhi H, El Ouahabi H. Reversible Gynecomastia in HIV-Infected Man Treated With Triple Antiretroviral Therapy Containing Efavirenz: A Case Report. Cureus 2022; 14:e27991. [PMID: 36120227 PMCID: PMC9469751 DOI: 10.7759/cureus.27991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/16/2022] Open
Abstract
Gynecomastia is benign hypertrophy of male breast glandular tissue, either unilateral or bilateral, secondary to increased estrogen/testosterone ratio (elevated estrogen level, decreased testosterone levels, or both). The condition can be related to a medical disease or caused by some drugs. Since the introduction of triple antiretroviral therapy (TAT), we have seen an improvement in the prognosis of human immunodeficiency virus (HIV) infection. Here we report the case of a 53-year-old man receiving follow-up care in Internal Medicine for HIV infection receiving TAT (tenofovir/efavirenz/emtricitabine). After one year, the patient presented in the Department of Endocrinology, Diabetology, Metabolic Diseases, and Nutrition of Hassan II University Hospital Center, Fez, with bilateral gynecomastia. Hormonal exploration did not reveal any abnormality, so the gynecomastia was attributed to efavirenz use. The regimen was replaced by tenofovir, lamivudine, and dolutegravir. The gynecomastia was resolved within two months of discontinuing efavirenz. In summary, we think that secondary gynecomastia should be suspected and screened in HIV patients receiving efavirenz-containing regimens.
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30
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Bharathidasan K, Curl J, Babu VK, Felton S, Nugent K. An Approach to Gynecomastia in Primary Care Clinics. South Med J 2022; 115:597-602. [PMID: 35922045 DOI: 10.14423/smj.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Gynecomastia is a more common finding in primary care clinics than is recognized. Because this finding can be easily overlooked, appropriate investigation and management often are missed. The workup of gynecomastia is highly individualized, based on the patient's presentation and related factors. It should be guided by thorough history taking and physical examination. Unless the patient has associated symptoms, or there is suspicion for an underlying clinical disorder causing the gynecomastia, the patient need not be investigated further. A breast ultrasound is not routinely recommended. Gynecomastia is a benign finding that will spontaneously regress in most patients; however, patients who are concerned with their physical appearance can be treated either medically or surgically. Patients who have had gynecomastia for more than 1 year tend to have fibrosis, which may be more difficult to treat. Management of gynecomastia is highly patient centered, following a detailed discussion about treatment goals and should be started early. Gynecomastia is not considered a premalignant condition; routine screening is not cost-effective, and imaging studies should be pursued only if physical examination findings suggest malignancy.
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Affiliation(s)
- Kavya Bharathidasan
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Jordan Curl
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Vedesh Kumar Babu
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Shaili Felton
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Kenneth Nugent
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
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31
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Crafa A, Condorelli RA, Cannarella R, Aversa A, Calogero AE, La Vignera S. Physical Examination for Endocrine Diseases: Does It Still Play a Role? J Clin Med 2022; 11:jcm11092598. [PMID: 35566722 PMCID: PMC9102568 DOI: 10.3390/jcm11092598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 02/01/2023] Open
Abstract
A physical examination represents a fundamental step in diagnosing diseases. Due to the role that hormones play in the regulation of numerous biological processes in various organs and systems, endocrine diseases cause a variety of clinical manifestations that can be easily identified with a careful physical examination and can guide the clinician to specific diagnoses. Furthermore, the presence of specific clinical signs in various endocrine-metabolic diseases can predict the risk of developing comorbidities and serious adverse events. In this article, we present some of the main clinical signs of endocrine-metabolic diseases and the risk of comorbidities, summarizing the pathogenetic mechanisms that lead to their formation. The aim is to highlight how the identification of these specific signs can reduce the number of dynamic tests and the costs necessary to reach the diagnosis and allow the early identification of any complications associated with these diseases, improving the clinical management of affected patients.
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Affiliation(s)
- Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.C.); (R.A.C.); (R.C.); (A.E.C.)
| | - Rosita A. Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.C.); (R.A.C.); (R.C.); (A.E.C.)
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.C.); (R.A.C.); (R.C.); (A.E.C.)
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.C.); (R.A.C.); (R.C.); (A.E.C.)
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.C.); (R.A.C.); (R.C.); (A.E.C.)
- Correspondence: ; Fax: +39-95-3781180
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Nordenström A, Ahmed SF, van den Akker E, Blair J, Bonomi M, Brachet C, Broersen LHA, Claahsen-van der Grinten HL, Dessens AB, Gawlik A, Gravholt CH, Juul A, Krausz C, Raivio T, Smyth A, Touraine P, Vitali D, Dekkers OM. Pubertal induction and transition to adult sex hormone replacement in patients with congenital pituitary or gonadal reproductive hormone deficiency: an Endo-ERN clinical practice guideline. Eur J Endocrinol 2022; 186:G9-G49. [PMID: 35353710 PMCID: PMC9066594 DOI: 10.1530/eje-22-0073] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
An Endo-European Reference Network guideline initiative was launched including 16 clinicians experienced in endocrinology, pediatric and adult and 2 patient representatives. The guideline was endorsed by the European Society for Pediatric Endocrinology, the European Society for Endocrinology and the European Academy of Andrology. The aim was to create practice guidelines for clinical assessment and puberty induction in individuals with congenital pituitary or gonadal hormone deficiency. A systematic literature search was conducted, and the evidence was graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. If the evidence was insufficient or lacking, then the conclusions were based on expert opinion. The guideline includes recommendations for puberty induction with oestrogen or testosterone. Publications on the induction of puberty with follicle-stimulation hormone and human chorionic gonadotrophin in hypogonadotropic hypogonadism are reviewed. Specific issues in individuals with Klinefelter syndrome or androgen insensitivity syndrome are considered. The expert panel recommends that pubertal induction or sex hormone replacement to sustain puberty should be cared for by a multidisciplinary team. Children with a known condition should be followed from the age of 8 years for girls and 9 years for boys. Puberty induction should be individualised but considered at 11 years in girls and 12 years in boys. Psychological aspects of puberty and fertility issues are especially important to address in individuals with sex development disorders or congenital pituitary deficiencies. The transition of these young adults highlights the importance of a multidisciplinary approach, to discuss both medical issues and social and psychological issues that arise in the context of these chronic conditions.
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Affiliation(s)
- A Nordenström
- Pediatric Endocrinology, Department of Women’s and Children’s Health Karolinska Institutet, and Department of Pediatric Endocrinology and Inborn Errors of Metabolism, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- Correspondence should be addressed to A Nordenström;
| | - S F Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Royal Hospital for Children, Glasgow, UK
| | - E van den Akker
- Division of Pediatric Endocrinology and Obesity Center CGG, Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Blair
- Department of Endocrinology, Alder Hey Children’s Hospital, Liverpool, UK
| | - M Bonomi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - C Brachet
- Pediatric Endocrinology Unit, Hôpital Universitaire des Enfants HUDERF, Université Libre de Bruxelles, Bruxelles, Belgium
| | - L H A Broersen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - H L Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Amalia Childrens Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A B Dessens
- Department of Child and Adolescent Psychiatry and Psychology, Sophia Children’s Hospital Erasmus Medical Center, Rotterdam, Netherlands
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - A Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
| | - C H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - A Juul
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- International Research and Research Training Centre for Endocrine Disruption in Male Reproduction and Child Health (EDMaRC) and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - C Krausz
- Department of Biochemical, Experimental and Clinical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
| | - T Raivio
- New Children’s Hospital, Pediatric Research Center, Helsinki University Hospital, and Research Program Unit, Faculty of Medicine, Stem Cells and Metabolism Research Program, University of Helsinki, Helsinki, Finland
| | - A Smyth
- Turner Syndrome Support Society in the UK, ePAG ENDO-ERN, UK
| | - P Touraine
- Department of Endocrinology and Reproductive Medicine, Pitié Salpêtriere Hospital, Paris, France
- Sorbonne Université Médecine and Center for Endocrine Rare Disorders of Growth and Development and Center for Rare Gynecological Disorders, Paris, France
| | - D Vitali
- SOD ITALIA APS – Italian Patient Organization for Septo Optic Dysplasia and Other Neuroendocrine Disorders – ePAG ENDO-ERN, Rome, Italy
| | - O M Dekkers
- Department of Clinical Epidemiology, LUMC Leiden, Leiden, The Netherlands
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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Iff S, Butzke I, Zitzmann M, Schneiter R, Hunziker M, Quednow BB, Claussen MC. [IPED Use in Recreational Sports]. PRAXIS 2022; 111:345-349. [PMID: 35473327 DOI: 10.1024/1661-8157/a003872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
IPED Use in Recreational Sports Abstract. Abtract: IPED consumers seek medical advice when uncertain as to their use. Due to shame or fear of stigmatization IPED consumers are often reluctant to talk about their drug use; they fear prejudice and a lack of experience when caring for this specific patient group. In order to strengthen trust, a non-judgmental, non-stigmatizing and supportive attitude is essential. The interaction should primarily lead to an understanding of why AAS are being used, what the patient's concerns are, and why medical help is being sought, without judgment or condemnation of the behavior. If no motivation to abstain from drug use is found during the consultation, harm reduction should be sought and the consequences of use addressed. Regular talks and active harm reduction can increase the confidence in evidence-based treatment to achieve personal motivation to abstain under medical supervision.
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Affiliation(s)
- Samuel Iff
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Zürich, Schweiz
| | - Ingo Butzke
- Klink für Psychose und Abhängigkeit, PZM Psychiatriezentrum Münsingen AG, Münsingen, Schweiz
| | - Michael Zitzmann
- Centrum für Reproduktionsmedizin und Andrologie, Abteilung für Klinische und Operative Andrologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Roger Schneiter
- Klinik für Endokrinologie/Diabetologie, Universitätsspital Zürich, Zürich, Schweiz
| | | | - Boris B Quednow
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Zürich, Schweiz
| | - Malte Christian Claussen
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Zürich, Schweiz
- Privatklinik Wyss AG, Münchenbuchsee, Schweiz
- Erwachsenenpsychiatrie, Psychiatrische Dienste Graubünden, Chur, Schweiz
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Iff S, Butzke I, Zitzmann M, Schneiter R, Hunziker M, Quednow BB, Claussen MC. IPED in Recreational Sports. PRAXIS 2022; 111:e345-e349. [PMID: 35473330 DOI: 10.1024/1661-8157/a003873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
IPED consumers seek medical advice when uncertain as to their use. Due to shame or fear of stigmatization IPED consumers are often reluctant to talk about their drug use; they fear prejudice and a lack of experience when caring for this specific patient group. In order to strengthen trust, a non-judgmental, non-stigmatizing and supportive attitude is essential. The interaction should primarily lead to an understanding of why AAS are being used, what the patient's concerns are, and why medical help is being sought, without judgment or condemnation of the behavior. If no motivation to abstain from drug use is found during the consultation, harm reduction should be sought and the consequences of use addressed. Regular talks and active harm reduction can increase the confidence in evidence-based treatment to achieve personal motivation to abstain under medical supervision.
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Affiliation(s)
- Samuel Iff
- Department of Psychiatry, Psychotherapy and Psychosomatic, Psychiatric University Hospital Zurich, University of Zurich, Switzerland
| | - Ingo Butzke
- Clinic for Psychosis and Addiction, PZM Psychiatry Center Münsingen AG, Münsingen, Switzerland
| | - Michael Zitzmann
- Center for Reproductive Medicine and Andrology, Department of Clinical and Operative Andrology, Münster University Hospital, Münster, Germany
| | - Roger Schneiter
- Department of Endocrinology/Diabetology, University Hospital Zurich, Zurich, Switzerland
| | - Manuela Hunziker
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Boris B Quednow
- Department of Psychiatry, Psychotherapy and Psychosomatic, Psychiatric University Hospital Zurich, University of Zurich, Switzerland
| | - Malte Christian Claussen
- Department of Psychiatry, Psychotherapy and Psychosomatic, Psychiatric University Hospital Zurich, University of Zurich, Switzerland
- Private Clinic Wyss AG, Münchenbuchsee, Switzerland
- Adult Psychiatry, Psychiatric Services Grisons, Chur, Switzerland
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Singh VP, Das L, Kumar P, Bal A, Gaba S, Tripathy S, Dutta P. The role of steroid receptors, peptides and growth factors in the aetiopathogenesis of idiopathic gynecomastia. Andrologia 2022; 54:e14414. [PMID: 35297077 DOI: 10.1111/and.14414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/07/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022] Open
Abstract
Idiopathic gynecomastia is a diagnosis of exclusion. We aimed to evaluate the role of steroids, peptides and growth factors in these patients. Those with bilateral idiopathic gynecomastia (n = 29) (Simon's grade IIb or III) who underwent gland excision were evaluated by immunohistochemical techniques using semi-quantitative grading for oestrogen receptor (ER), progesterone receptor (PR), aromatase, androgen receptor (AR), peptides (IGF-1, IGF-2, HER-2, parathyroid-hormone related peptide [PTHrP]) and growth factors (EGFR, TGFβ). The cohort comprised 29 patients, with a mean age of 25.3 ± 5.1 years and a mean body mass index of 27.2 ± 2.3 kg/m2 . Grade IIb gynecomastia was present in 79.1% and moderate-to-severe insulin resistance (HOMA-IR >3) in 53.7% of patients. ER expression was positive in 100% samples, followed by AR (96.5%), aromatase (96.5%) and PR (93.1%). IGF-1 was expressed in 86.2% of the cohort, IGF2 in 27.5% and HER-2 in only two samples, with both showing weak immunoexpression. None of the patients had positive expression of EGFR, TGF-β or PTHrP. There was no association between immunoexpression and gynecomastia grade. This study demonstrates the predominant role of oestrogen, aromatase and insulin resistance in the aetiopathogenesis of idiopathic gynecomastia and implicates the paracrine hyperestrogenic milieu in its causation as circulating hormones were normal.
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Affiliation(s)
- Vinay Pal Singh
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Liza Das
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Parmod Kumar
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, PGIMER, Chandigarh, India
| | - Sunil Gaba
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satyaswarup Tripathy
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India
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Villalta D, Quintos JB. Gonadotropin Suppression for 7 Years After a Single Histrelin Implant for Precocious Puberty. J Endocr Soc 2022; 6:bvab189. [PMID: 35047716 PMCID: PMC8758400 DOI: 10.1210/jendso/bvab189] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
Gonadotropin-releasing hormone analogues (GnRHas) are an effective treatment to address the compromise in height potential seen in patients with central precocious puberty. There is no evidence in the literature of a single GnRHa used for longer than 2 years before being removed or replaced. We describe a patient who was on continuous gonadotropin suppression for 7 years and despite this, achieved a height potential within 1 SD of mid-parental height. A boy aged 10 years 3 months presented to the endocrine clinic with signs of precocious puberty and advanced bone age. Initial laboratory values were a random luteinizing hormone (LH) level of 9.4 mIU/mL, follicle-stimulating hormone (FSH) 16.3 mIU/mL, dehydroepiandrosterone sulfate 127 mcg/dL, and testosterone 628 ng/dL. The patient was initially started on Lupron injections before transitioning to a histrelin implant. Follow-up laboratory results 5 months post-suppression showed pre-pubertal random LH 0.2 mIU/mL, FSH 0.1 mIU/mL, and testosterone 5 ng/dL. The patient was lost to follow-up and returned 5 years later presenting with gynecomastia and delayed bone age. He had continuous gonadotropin suppression with random LH 0.10 mIU/mL, FSH 0.16 mIU/mL, and testosterone 8 ng/dL. The histrelin implant was removed, and 4 months later, his random pubertal hormone levels were LH 5.6 mIU/mL, FSH 4.3 mIU/mL, and testosterone 506 ng/dL. The patient’s mid-parental height was 175.3 cm and his near final height was 170.6 cm, which is within 1 SD of his genetic potential. Further studies are needed to explore continuous gonadotropin hormone suppression with a single histrelin implant beyond 2 years.
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Affiliation(s)
- Douglas Villalta
- The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Jose B Quintos
- Division of Pediatric Endocrinology, Rhode Island Hospital/Hasbro Children's Hospital-The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Berger O, Landau Z, Talisman R. Gynecomastia: A systematic review of pharmacological treatments. Front Pediatr 2022; 10:978311. [PMID: 36389365 PMCID: PMC9663914 DOI: 10.3389/fped.2022.978311] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pubertal gynecomastia (PG), a benign condition with varied reported prevalence, typically appears at 13-14 years-old and is mostly idiopathic and self-limited. Psychologic impairments are common among adolescents with gynecomastia. Surgical intervention is reserved to severe cases and is offered towards the end of puberty. Pharmacological treatment is seldom given by clinicians mainly due to insufficient published data. We conducted this systematic literature review to assess the efficacy, safety, side effects, and complications of pharmacological treatments published. METHODS MEDLINE, Embase, and Cochrane CENTRAL were searched for the terms "gynecomastia", "pubertal", and "adolescent" in conjunction with medications from the Selective Estrogen Receptor Modulator (SERM), aromatase inhibitors (AI), and androgens groups in different combinations to optimize the search results. Exclusion criteria included: studies based on expert opinion, similar evidence-based medicine levels studies, and studies which discuss gynecomastia in adults. Selected articles were assessed by two authors. Data collected included: the level of evidence, population size, treatment regimen, follow-up, outcomes, complications, and side effects. RESULTS Of 1,425 published studies found and examined meticulously by the authors, only 24 publications met all the study research goals. These were divided into 16 publications of patients treated with SERM, of whom four had AI and four androgens. In general, the data regarding pharmacologic therapy for PG is partial, with insufficient evidence-based research. Tamoxifen and SERM drugs have long been used as treatments for PG. Tamoxifen was the chosen drug of treatment in most of the reviewed studies and found to be effective, safe, and with minimal side effects. CONCLUSIONS Pharmacological treatment as a new standard of care has an advantage in relieving behavioral and psychological distress. Although high quality publications are lacking, pharmacological intervention with tamoxifen is appropriate in select patients. Conduction large-scale high-quality studies are warranted with various drugs.
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Affiliation(s)
- Ori Berger
- Plastic Surgery Unit, Barzilai University Hospital Medical Center, Ashkelon, Israel
| | - Zohar Landau
- Division of Pediatrics, Barzilai University Medical Center, Ashkelon, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ran Talisman
- Plastic Surgery Unit, Barzilai University Hospital Medical Center, Ashkelon, Israel
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Trinchieri A, Perletti G, Magri V, Stamatiou K, Trinchieri M, Montanari E. Drug-induced gynecomastia: A systematic review and meta-analysis of randomized clinical trials. Arch Ital Urol Androl 2021; 93:489-496. [PMID: 34933535 DOI: 10.4081/aiua.2021.4.489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To review the evidence concerning treatment-related gynecomastia in patients taking spironolactone, antiandrogens, 5 alpha-reductase inhibitors, lipid-lowering and psychotropic drugs. MATERIAL AND METHODS A search of Medline and EMBASE was performed up to 30 June 2021. We included randomized controlled trials comparing the effects of a drug belonging to these classes versus placebo or versus a drug of the same class. RESULTS A total of 32 randomized controlled trials were included in the final review. There was an increased odds of gynecomastia in men receiving antiandrogens (OR = 17.38, 95% CI: 11.26 to 26.82; 6 trials, 9599 participants) and 5 alpha-reductase inhibitors compared to controls (OR = 1.77, 95% CI: 1.53 to 2.06; 7 series out of 6 trials, 34860 participants). The use of spironolactone in mixed gender populations was characterized by significantly higher odds of having gynecomastia compared to controls (OR = 8.39, 95% CI: 5.03 to 13.99; 14 trials, 3745 participants). No placebo-controlled trials focusing on the risk of gynecomastia in patients taking antipsychotic drugs was available, although there was a significant difference in the odds of having gynecomastia in a comparison between risperidone and quetiapine (OR = 4.32, 95% CI: 1.31 to 14.27; 3 trials, 343 participants). Limited evidence about the effects of statins on mammary glands was found. CONCLUSIONS Antiandrogens and to a lesser extent 5 alphareductase inhibitors and spironolactone are associated with an increased risk of developing gynecomastia. Such effect can be explained by a modification of the testosterone to estradiol ratio. Gynecomastia (and galactorrhea) associated to the use of conventional and certain atypical antipsychotics can be related to high prolactin levels.
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Affiliation(s)
| | - Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese, Italy; Faculty of Medicine and Medical Sciences, Ghent University.
| | | | | | | | - Emanuele Montanari
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan.
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Голодников ИИ, Павлова ЗШ, Камалов АА. [Testosterone replacement therapy and its relationship with hyperestrogenism and obesity. Problems of laboratory diagnostics of hyperestrogenism]. PROBLEMY ENDOKRINOLOGII 2021; 68:101-108. [PMID: 35262301 PMCID: PMC9761874 DOI: 10.14341/probl12742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 01/09/2023]
Abstract
Testosterone replacement therapy (TRT) is one of the most effective and common treatments for testosterone deficiency today. It is often prescribed, focusing only on the level of testosterone and the presence of patient complaints about a decrease in sexual function. Quite rarely, doctors additionally assess the level of estradiol and, as a consequence, the initial presence of a symptom of hyperestrogenism. One of the likely consequences of the appointment of TRT may be an excess of estradiol, the excess formation of which is associated with the enzyme aromatase, which converts testosterone into estradiol. Despite the availability of laboratory determination of the level of estradiol, the result may not always coincide with the clinical picture, one of the reasons is the difference in the methods for determining the level of estradiol in each laboratory, there is no single standard or «reference» today. This article describes the evolution of TRT, and also focuses on the variability of estradiol levels from laboratory to laboratory, and explains in detail why the assessment of estradiol over time should be carried out in only one laboratory. A systematic literature search was carried out in the databases Medline, Scopus, Web of Science and Elibrary, CyberLeninka.The purpose of our review was the need to engage the attention of specialists to the problem of hyperestrogenism, the not always justified prescription of TRT in patients with obesity, hypogonadism and hyperestrogenism, as well as to the problem of laboratory diagnosis of hyperestrogenism, which is acute not only in our country, but all over the world.
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Affiliation(s)
- И. И. Голодников
- Российская медицинская академия непрерывного профессионального образования Минздрава России
| | - З. Ш. Павлова
- Медицинский научно-образовательный центр МГУ им. М.В. Ломоносова
| | - А. А. Камалов
- Медицинский научно-образовательный центр МГУ им. М.В. Ломоносова
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40
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Nnamani Silva ON, Ammanuel SG, Segobiano BM, Edwards CS, Hoffman WY. Assessing the Readability of Online Patient Education Resources Related to Gynecomastia. Ann Plast Surg 2021; 87:123-125. [PMID: 33346559 DOI: 10.1097/sap.0000000000002620] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Internet has a plethora of online patient education resources for many symptoms and diseases. National medical governing bodies recommend that patient education materials are written at or below the eighth-grade level, and the literature suggests that health literacy has been linked to increased adherence to treatment regimens and improved outcomes. The primary aim of the study is to assess the readability of online patient materials relating to gynecomastia and ascertain the availability of patient materials in non-English languages. METHODS The readability of patient education materials relating to gynecomastia for academic-based websites and nonacademic websites was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG). The prevalence of non-English patient education materials was assessed for both academic-based and nonacademic websites. RESULTS Fifty-eight documents were collected across academic websites. Overall median values were 10.7 for the FKGL, 47.0 for the FRE, and 11.4 for the SMOG. For the 10 nonacademic institutions, the overall median values were 10.6 for the FKGL, 45.2 for the FRE, and 10.8 for the SMOG. No appreciable differences were observed for readability when stratified by region or source. The prevalence of non-English patient materials was 19.1% across institutions. None of the noninstitutional materials had information in non-English languages. CONCLUSIONS The readability of patient education materials related to gynecomastia is at higher levels than recommended by national organizations. There are limited non-English patient education materials. Future efforts should focus on improving the readability and accessibility of patient materials.
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Affiliation(s)
| | - Simon G Ammanuel
- From the University of California, San Francisco School of Medicine, San Francisco, CA
| | - Brett M Segobiano
- College of Arts and Letters, University of Notre Dame, South Bend, IN
| | - Caleb S Edwards
- From the University of California, San Francisco School of Medicine, San Francisco, CA
| | - William Y Hoffman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
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Corona G, Rastrelli G, Marchiani S, Filippi S, Morelli A, Sarchielli E, Sforza A, Vignozzi L, Maggi M. Consequences of Anabolic-Androgenic Steroid Abuse in Males; Sexual and Reproductive Perspective. World J Mens Health 2021; 40:165-178. [PMID: 34169679 PMCID: PMC8987149 DOI: 10.5534/wjmh.210021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022] Open
Abstract
The real epidemiology and the possible consequences of anabolic-androgenic steroids (AAS) use still represent a very tricky task due to the difficulties in the quantification and detection of these drugs. Chronic use of AAS, frequently combined with other illicit substances, can induce tremendous negative effects on the reproductive system, but it is also associated with an increased overall and cardiovascular mortality risk. In the present review we summarize and discuss the available evidence regarding the negative impact of AAS on the male reproductive system, providing practical suggestions to manage these problems. For this purpose a meta-analysis evaluating the effects of AAS abusers vs. controls on several hormonal, reproductive and metabolic parameters was performed. In addition, in order to overcome possible limitations related to the combined use of different AAS preparations, we also retrospectively re-analyzed data on animal models treated with supraphysiological dosage of testosterone (T), performed in our laboratory. Available data clearly indicated that AAS negatively affect endogenous T production. In addition, increased T and estradiol circulating levels were also observed according to the type of preparations used. The latter leads to an impairment of sperm production and to the development of side effects such as acne, hair loss and gynecomastia. Furthermore, a worse metabolic profile, characterized by reduced high density lipoprotein and increased low density lipoprotein cholesterol levels along with an increased risk of hypertension has been also detected. Finally sexual dysfunctions, often observed upon doping, represent one the most probable unfavorable effects of AAS abuse.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda-Usl Bologna, Maggiore-Bellaria Hospital, Bologna, Italy.
| | - Giulia Rastrelli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Sara Marchiani
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Sandra Filippi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Annamaria Morelli
- Section of Human Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Erica Sarchielli
- Section of Human Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandra Sforza
- Endocrinology Unit, Medical Department, Azienda-Usl Bologna, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Linda Vignozzi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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Billa E, Kanakis GA, Goulis DG. Imaging in gynecomastia. Andrology 2021; 9:1444-1456. [PMID: 34033252 DOI: 10.1111/andr.13051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gynecomastia (GM) is the benign proliferation of glandular tissue in the male breast. It is a common condition, which may occur physiologically and shows three age peaks during a male's lifespan: infancy, puberty, and senescence. An underlying pathology may be revealed in 45%-50% of adult men with GM, such as aggravating medications, systemic diseases, obesity, endocrinopathies, or malignancy. OBJECTIVE To discuss the role of imaging in the evaluation of GM and its contribution to therapeutic decision-making. MATERIALS/METHODS The current literature was reviewed through PubMed, Scopus, and CENTRAL electronic databases to identify the best available evidence concerning imaging modalities in patients with GM. RESULTS Most male breast lesions can be diagnosed on clinical grounds; however, in certain cases, when physical examination is inconclusive, imaging may be helpful. DISCUSSION The main purpose of evaluating a patient with GM is to establish the diagnosis and differentiate true GM from pseudogynecomastia, exclude breast cancer, and detect the possible cause. GM is seen in mammography as a subareolar opacity and three mammographic patterns of GM are described: nodular, dendritic, and diffuse, corresponding to florid GM of early onset, fibrous persistent GM, and GM due to exogenous estrogen administration, respectively. In ultrasound (US), florid GM is depicted as a disk-shaped, hypoechoic area underlying the areola, whereas echogenicity of the lesions increases as fibrosis develops. Data on the use of MRI in the evaluation of the male breast and GM are still limited. Imaging findings can be classified according to the BIRADS (breast imaging reporting and data system) based on their malignant potential. CONCLUSION Both mammography and US are sensitive and specific to diagnose GM and distinguish it from breast cancer. When clinical findings are suggestive of malignancy or imaging findings are inconclusive, a histological confirmation should be sought.
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Affiliation(s)
- Evangelia Billa
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George A Kanakis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Endocrinology, Athens Naval and Veteran Affairs Hospital, Athens, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Mohammadnia N, Simsek S, Stam F. Gynecomastia as a presenting symptom of Graves' disease in a 49-year-old man. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM200181. [PMID: 33880994 PMCID: PMC8115411 DOI: 10.1530/edm-20-0181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/29/2021] [Indexed: 11/11/2022] Open
Abstract
SUMMARY Gynecomastia is a symptom with a potential high disease burden. It has a variety of underlying causes, such as malignant, drug-related or hormonal. The presence of gynecomastia can be explained in thyrotoxicosis due to a concomitant disbalance of sex hormones. Interestingly, it rarely is the presenting symptom of Graves' disease. A 49-year-old man presented to our outpatient clinic with right-sided gynecomastia. After thorough history taking, more symptoms of thyrotoxicosis were present. Treatment was started with thiamazole and later levothyroxine. Three months after this treatment the gynecomastia and other symptoms resolved completely. A disbalance of sex hormones due to an increased expression of the protein sex hormone-binding globulin (SHBG) caused by thyrotoxicosis could result in gynecomastia. In vitro and in vivo research in mice suggest that the pathophysiology of thyrotoxicosis-associated gynecomastia is due to upregulation of hepatocyte nuclear factor-4α (HNF4A) in liver cells. Subsequent increase of SHBG results in a decrease of free testosterone levels. LEARNING POINTS Gynecomastia is a common finding (up to almost 40%) on physical examination in patients with hyperthyroidism. In gynecomastia, thyroid function tests should be examined on initial presentation because of the relative simple treatment. The pathophysiology of thyrotoxicosis-associated gynecomastia is well understood by a sex-hormonal disbalance due to an increased expression of SHBG. Due to the well explainable pathophysiology, reduction of symptoms can be expected after treatment. The underlying mechanism of an increased expression of SHBG is not well understood. However, in vitro and in vivo research in mice suggests that thyrotoxicosis causes an increased expression of HNF4A in liver cells. Thus, upregulating the expression of SHBG. Interestingly, HNF4A is suspected to play an important role in MODY. Future research will clarify the importance of this gene and might open up new insights for therapy.
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Affiliation(s)
- N Mohammadnia
- Department of Internal MedicineNorthwest Clinics, Alkmaar, the Netherlands
| | - S Simsek
- Department of Internal MedicineNorthwest Clinics, Alkmaar, the Netherlands
| | - F Stam
- Department of Internal MedicineNorthwest Clinics, Alkmaar, the Netherlands
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Fiorini A, Sepich M, Pontrelli M, Sangriso G, Cosci O Di Coscio M, Lauletta M, Baldinotti F, Peroni D, Ambrosio MR, Bertelloni S. Adolescent Gynecomastia due to Minimal Androgen Resistance Syndrome: A Case Report and Literature Review. Sex Dev 2021; 14:21-26. [PMID: 33691326 DOI: 10.1159/000514067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/25/2020] [Indexed: 11/19/2022] Open
Abstract
A 14-year-old boy with a 46,XY karyotype and persistent breast-3-stage gynecomastia is reported. The reproductive axis was investigated by standard laboratory methods and the androgen receptor (AR) gene was sequenced. Also, a literature review of phenotypes associated with the AR genetic variant p.Pro392Ser was performed. The boy presented with height in the upper normal range (+1.9 SDS) and normal body mass index (-0,3 SDS); pubertal development was PH5/G4 (mean testicular volume 15 mL; 0 SDS). Laboratory findings were normal for age and sex, except aromatization index (0.09; reference range 0.03-0.07). Analysis of the AR gene showed the single nucleotide variant c.1174C>T (p.Pro392Ser) in exon 1, leading to the diagnosis of minimal androgen insensitivity syndrome (AIS). This genetic variant is reported in other 8 patients with AIS and is associated with variable clinical phenotypes ranging from complete to partial and minimal AIS. To the best of our knowledge, this is the first adolescent in whom the p.Pro392Ser mutation is associated with isolated persistent gynecomastia. The underlying reason of phenotypic variability due to this AR mutation remains unknown. Persistent gynecomastia due to minimal AIS has been reported in few additional males with variable AR mutations. Since fertility troubles may occur in adult men with minimal AIS, early diagnosis can allow optimizing the clinical management.
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Affiliation(s)
- Aureliano Fiorini
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Margherita Sepich
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Margherita Pontrelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giorgio Sangriso
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Mirna Cosci O Di Coscio
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Marcella Lauletta
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Fulvia Baldinotti
- Section of Molecular Genetics, Department of Laboratory Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Diego Peroni
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Maria Rosaria Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Silvano Bertelloni
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy,
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45
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Acharya SV. Clinical features, presentation and hormonal parameters in patients with pubertal gynecomastia. J Family Med Prim Care 2021; 10:648-651. [PMID: 34041055 PMCID: PMC8138374 DOI: 10.4103/jfmpc.jfmpc_1987_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/02/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
Objective: Gynecomastia is benign enlargement of breast in male. It is postulated that its development is primarily due to a mismatch in ratio of oestrogen and androgen at breast tissue. The aim of this study was to highlight the clinical features, presentation and hormonal parameters at the time of consultation. Methods: All adolescent patients who attended endocrinology department with the complaint of breast enlargement were taken into study. We analysed their thyroid function test, oestrogen, testosterone, prolactin, alpha-fetoprotein, follicle-stimulating hormone, luteinizing hormone, beta HCG (human chorionic gonadotropin) and liver function. Clinical features and anthropometry were recorded. Results: Out of 50 patients enrolled, 34 (68%) had bilateral gynaecomastia while 16 patients (32%) had unilateral disease. Mastalgia was seen in 44 patients (88%). Psychological disturbance in the form of depression was seen in 60% of adolescent boys with gynecomastia. Tanner stage B had positive correlation with oestrogen to testosterone (E2/TTE) ratio (r = 0.47; P = 0.034). All other hormonal parameters were normal. Conclusion: Mastalgia was one of the presenting complaints in majority of patients and many had bilateral enlargement. Altered oestrogen to testosterone ratio is altered in majority of patients thus may be reason for pubertal gynecomastia.
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Affiliation(s)
- Shrikrishna V Acharya
- Consultant Endocrinologist K S Hegde Medical Academy Nitte University Mangalore, Karnataka, India
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46
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Vita R, Capodicasa G, Di Bari F, Amadeo G, Stagno D'Alcontres F, Benvenga S. Biochemical features of eugonadal patients with idiopathic gynaecomastia: A retrospective cross-sectional study. Andrologia 2021; 53:e13962. [PMID: 33411368 DOI: 10.1111/and.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022] Open
Abstract
Patients with idiopathic gynaecomastia have greater BMI and an unfavourable lipid profile compared with age-matched controls. Twenty-five adult eugonadal patients with idiopathic gynaecomastia and 50 age- and BMI-matched controls were selected. Clinical and biochemical parameters and ultrasound testis volume were reviewed retrospectively. Patients and controls differed for no biochemical parameter, except for LH levels, which were 31% higher in patients (p = 0.019), although within the normal range. Compared with controls, patients had a threefold greater rate of elevated LDL-c (p = 0.025). Patients ≥ 25 years had higher levels of serum LDL-c compared with either patients < 25 years (p = 0.006) or controls ≥ 25 years (p = 0.012). In patients, both at bivariate analysis and at linear regression, age correlated positively with total cholesterol and LDL-c, the latter correlated inversely with total testosterone. Negative interactions were found for age and total testosterone with LDL-c, for LH and estradiol to testosterone ratio (E2:T) with LDL-c, and for age and E2:T with total cholesterol. Our data suggest inadequate local androgen action in patients with idiopathic gynaecomastia. This partial androgen resistance might blunt the beneficial effects of testosterone on lipid metabolism. Further studies are needed to verify whether this metabolic derangement impacts the cardiovascular health of these patients.
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Affiliation(s)
- Roberto Vita
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Capodicasa
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Flavia Di Bari
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Salvatore Benvenga
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.,Interdepartmental Program of Molecular & Clinical Endocrinology, and Women's Endocrine Health, University Hospital, Policlinico Universitario G. Martino, Messina, Italy
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47
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Wit JM. Should Skeletal Maturation Be Manipulated for Extra Height Gain? Front Endocrinol (Lausanne) 2021; 12:812196. [PMID: 34975773 PMCID: PMC8716689 DOI: 10.3389/fendo.2021.812196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/23/2021] [Indexed: 01/18/2023] Open
Abstract
Skeletal maturation can be delayed by reducing the exposure to estrogens, either by halting pubertal development through administering a GnRH analogue (GnRHa), or by blocking the conversion of androgens to estrogens through an aromatase inhibitor (AI). These agents have been investigated in children with growth disorders (off-label), either alone or in combination with recombinant human growth hormone (rhGH). GnRHa is effective in attaining a normal adult height (AH) in the treatment of children with central precocious puberty, but its effect in short children with normal timing of puberty is equivocal. If rhGH-treated children with growth hormone deficiency or those who were born small-for-gestational age are still short at pubertal onset, co-treatment with a GnRHa for 2-3 years increases AH. A similar effect was seen by adding rhGH to GnRHa treatment of children with central precocious puberty with a poor AH prediction and by adding rhGH plus GnRHa to children with congenital adrenal hyperplasia with a poor predicted adult height on conventional treatment with gluco- and mineralocorticoids. In girls with idiopathic short stature and relatively early puberty, rhGH plus GnRHa increases AH. Administration of letrozole to boys with constitutional delay of growth puberty may increase AH, and rhGH plus anastrozole may increase AH in boys with growth hormone deficiency or idiopathic short stature, but the lack of data on attained AH and potential selective loss-of-follow-up in several studies precludes firm conclusions. GnRHas appear to have a good overall safety profile, while for aromatase inhibitors conflicting data have been reported.
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Zitzmann M, Aksglaede L, Corona G, Isidori AM, Juul A, T'Sjoen G, Kliesch S, D'Hauwers K, Toppari J, Słowikowska-Hilczer J, Tüttelmann F, Ferlin A. European academy of andrology guidelines on Klinefelter Syndrome Endorsing Organization: European Society of Endocrinology. Andrology 2020; 9:145-167. [PMID: 32959490 DOI: 10.1111/andr.12909] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Knowledge about Klinefelter syndrome (KS) has increased substantially since its first description almost 80 years ago. A variety of treatment options concerning the spectrum of symptoms associated with KS exists, also regarding aspects beyond testicular dysfunction. Nevertheless, the diagnostic rate is still low in relation to prevalence and no international guidelines are available for KS. OBJECTIVE To create the first European Academy of Andrology (EAA) guidelines on KS. METHODS An expert group of academicians appointed by the EAA generated a consensus guideline according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. RESULTS Clinical features are highly variable among patients with KS, although common characteristics are severely attenuated spermatogenesis and Leydig cell impairment, resulting in azoospermia and hypergonadotropic hypogonadism. In addition, various manifestations of neurocognitive and psychosocial phenotypes have been described as well as an increased prevalence of adverse cardiovascular, metabolic and bone-related conditions which might explain the increased morbidity/mortality in KS. Moreover, compared to the general male population, a higher prevalence of dental, coagulation and autoimmune disorders is likely to exist in patients with KS. Both genetic and epigenetic effects due to the supernumerary X chromosome as well as testosterone deficiency contribute to this pathological pattern. The majority of patients with KS is diagnosed during adulthood, but symptoms can already become obvious during infancy, childhood or adolescence. The paediatric and juvenile patients with KS require specific attention regarding their development and fertility. CONCLUSION These guidelines provide recommendations and suggestions to care for patients with KS in various developmental stages ranging from childhood and adolescence to adulthood. This advice is based on recent research data and respective evaluations as well as validations performed by a group of experts.
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Affiliation(s)
- Michael Zitzmann
- Center for Reproductive Medicine and Andrology/Clinical and Surgical Andrology, University Hospital of Münster, Münster, Germany
| | - Lise Aksglaede
- Rigshospitalet, Department of Growth and Reproduction, University of Copenhagen, Copenhagen, Denmark
| | - Giovanni Corona
- Medical Department, Endocrinology Unit, Maggiore Bellaria Hospital, Azienda Usl, Bologna, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Advanced Endocrine Diagnostics Unit, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Anders Juul
- Rigshospitalet, Department of Growth and Reproduction, University of Copenhagen, Copenhagen, Denmark
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Sabine Kliesch
- Center for Reproductive Medicine and Andrology/Clinical and Surgical Andrology, University Hospital of Münster, Münster, Germany
| | - Kathleen D'Hauwers
- Department of Urology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Jorma Toppari
- Department of Pediatrics, Institute of Biomedicine, Research Centre for Integrated Physiology and Pharmacology and Centre for Population Health Research, University Hospital, University of Turku, Turku, Finland
| | | | - Frank Tüttelmann
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
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Koch T, Bräuner EV, Busch AS, Hickey M, Juul A. Marked Increase in Incident Gynecomastia: A 20-Year National Registry Study, 1998 to 2017. J Clin Endocrinol Metab 2020; 105:5868100. [PMID: 32754750 DOI: 10.1210/clinem/dgaa440] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/03/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Gynecomastia, the proliferation of mammary glandular tissue in the male, is a frequent but little-studied condition. Available prevalence data are based on selected patient populations or autopsy cases with their inherent bias. OBJECTIVE The objective of this work is to evaluate the age-related incidence and secular trends in gynecomastia in the general population. DESIGN An observational, 20-year national registry study was conducted. SETTING This population-based study used nationwide registry data. PARTICIPANTS Participants included all Danish males (age 0-80 years) with a first-time diagnosis of gynecomastia. MAIN OUTCOME MEASURES All Danish males (age 0-80 years) were followed up for incident diagnosis of gynecomastia in the Danish National Patient Registry from 1998 to 2017 using the International Codes of Diseases, 10th revision, and the Danish Health Care Classification System. Age-specific incidence rates were estimated. The hypothesis tested in this study was formulated prior to data collection. RESULTS Overall, a total 17 601 males (age 0-80 years) were registered with an incident diagnosis of gynecomastia within the 20-year study period, corresponding to 880 new cases per year and an average 20-year incidence of 3.4 per 10 000 men (age 0-80 years). The average annual incidence was 6.5/10 000 in postpubertal males age 16 to 20 years and 4.6/10 000 in males age 61 to 80 years, with a respective 5- and 11-fold overall increase in these 2 age groups over the 20-year period. CONCLUSIONS The incidence of gynecomastia has dramatically increased over the last 20 years, implying that the endogenous or exogenous sex-steroid environment has changed, which is associated with other adverse health consequences in men such as an increased risk of prostate cancer, metabolic syndrome, type 2 diabetes, or cardiovascular disorders.
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Affiliation(s)
- Trine Koch
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elvira V Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alexander S Busch
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Anders Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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50
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Rosas SL, Deyo-Svendsen ME, Oldfather RZ, Phillips MR, Israel TA, Weisenbeck ER. Gynecomastia in a Patient Taking Meloxicam-A Case Report. J Prim Care Community Health 2020; 11:2150132720952622. [PMID: 32951498 PMCID: PMC7502990 DOI: 10.1177/2150132720952622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Gynecomastia is benign enlargement of glandular tissue in the male breast. It occurs due to an imbalance of estrogen and testosterone. It may be unilateral or bilateral. Physiologic gynecomastia commonly occurs in infants and during puberty and is self-limited. Gynecomastia may affect up to 50% of adult men over age 50 years old and can be related to underlying medical illness or caused by certain medications. Known causative agents include anti-androgenic and estrogenic drugs. Probable agents include alcohol and anti-ulcer, psychoactive, and antiretroviral medications. Non-steroidal anti-inflammatory drugs (NSAIDs) are not commonly associated with the development of gynecomastia. This case presents an instance in which the NSAID, meloxicam, was the only identified variable in a patient who developed unilateral gynecomastia. His breast tenderness and abnormal exam resolved spontaneously within 4 weeks of cessation of meloxicam therapy.
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Affiliation(s)
- Steven L Rosas
- Department of Family Medicine, Mayo Clinic Health System - Northwest Wisconsin, Menomonie, WI, USA
| | - Mark E Deyo-Svendsen
- Department of Family Medicine, Mayo Clinic Health System - Northwest Wisconsin, Menomonie, WI, USA
| | | | - Michael R Phillips
- Department of Family Medicine, Mayo Clinic Health System - Northwest Wisconsin, Menomonie, WI, USA
| | - T Andrew Israel
- Department of Orthopedic Surgery, Mayo Clinic Health System - Northwest Wisconsin, Eau Claire, WI, USA
| | - Emily R Weisenbeck
- Department of Family Medicine, Mayo Clinic Health System - Northwest Wisconsin, Menomonie, WI, USA
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