Mammary gigantism and D-penicillamine

Bucillamine-induced gigantomastia with galactorrhea and hyperprolactinaemia

Gigantomastia is characterised by excessive breast growth and can occur as a rare, drug-induced adverse event. D-penicillamine is the most frequent cause of drug-induced gigantomastia. Only one case of gigantomastia due to bucillamine, an analogue of D-penicillamine, has been reported so far. We herein report a case of bucillamine-induced gigantomastia presenting with acute enlargement of the bilateral breasts and accessory breast tissue in the axillae 7 months after the start of bucillamine therapy. Awareness about this rare adverse event is important since bucillamine is still widely used in Japan and Korea.

Breast enlargement induced by D-penicillamine

OBJECTIVE

To report a patient with reversible breast enlargement due to D-penicillamine treatment for scleroderma.

CASE SUMMARY

A 55-year-old white woman developed enlarged breasts during D-penicillamine therapy for scleroderma. The enlargement regressed following discontinuation of the drug, and planned breast reduction surgery was avoided.

DISCUSSION

D-Penicillamine has been used in the treatment of various diseases including scleroderma. Breast enlargement has been previously described as a rare adverse effect of this drug. The enlargement subsided following discontinuation of the medication.

CONCLUSIONS

Attention is called to this rare adverse effect in an effort to avoid unnecessary diagnostic or therapeutic procedures, including surgery.

Massive breast enlargement in an infant girl with central nervous system dysfunction

A 6-month-old female is described who presented with severe idiopathic macromastia. The breast enlargement began at 2 months of age and progressed such that subtotal mastectomies were necessary at 23 months. Extensive hormonal evaluation prior to surgery revealed no evidence of estrogenization or precocious puberty. There was no galactorrhea. A breast biopsy showed immature mammary tissue. In vitro analysis of the patient's serum using a mouse mammary thymidine incorporation assay revealed similar mitogenic activity in the patient's serum compared to adult controls. Post surgical follow up of this patient, 3.5 years later, has revealed no breast enlargement, precocious sexual development, or growth acceleration. Of interest, however, she has manifested an idiopathic degenerative neurologic condition characterized by psychomotor delay, ataxia, and seizures. Remarkably, hormone studies at age 5.5 years showed an exaggerated gonadotrophin response to intravenous gonadotrophin releasing hormone and prepubertal estrogen levels. While this case may represent an extraordinary example of idiopathic premature thelarche, the severe nature of this infant's macromastia in association with neurologic dysfunction and increased gonadotrophins suggests that central nervous system factors were etiologic.