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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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Yu J, Lenord J, Lau M, Brunel L, Gray R, Donahoe SL, Boland L. Gynaecomastia in a male neutered cat with an adrenal tumour and associated hyperprogesteronism, hypercortisolism and hyperaldosteronism. JFMS Open Rep 2021; 7:20551169211045640. [PMID: 34616560 PMCID: PMC8488528 DOI: 10.1177/20551169211045640] [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: 11/30/2022] Open
Abstract
Case summary A 7-year-old male neutered domestic longhair cat was presented with chronic progressive gynaecomastia, polydipsia, polyphagia, weight loss and poor fur regrowth. Sexualised behavioural changes were not reported and virilisation was not present on physical examination. Pertinent haematology, biochemistry and urinalysis findings at the time of referral included mild hypokalaemia. Left adrenomegaly and mild prostatomegaly were identified on a CT scan. Evaluation of adrenal hormones with a low-dose dexamethasone suppression test, serum progesterone, testosterone, oestradiol, plasma aldosterone, renin, plasma metanephrine and normetanephrine measurement supported a diagnosis of hyperprogesteronism, hyperaldosteronism and hypercortisolism. Adrenalectomy was performed and histopathology was consistent with an adrenocortical tumour. Clinical signs and hormone elevations resolved postoperatively. Relevance and novel information To our knowledge, this is the second report of gynaecomastia secondary to an adrenal tumour in a male neutered cat and the first associated with hyperprogesteronism.
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Affiliation(s)
- Jane Yu
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Jason Lenord
- Balmain Veterinary Hospital, Rozelle, NSW, Australia
| | - Michelle Lau
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Laurencie Brunel
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Rachael Gray
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Shannon L Donahoe
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Lara Boland
- Valentine Charlton Cat Centre, University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
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Feminizing adrenal tumor with progesterone receptors. Med Clin (Barc) 2020; 156:100-101. [PMID: 32165004 DOI: 10.1016/j.medcli.2019.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 11/20/2022]
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Gibbons SM, Jassam N, Abbas A, Stuart K, Fairhurst A, Barth JH. Gynaecomastia caused by a feminizing adrenal tumour. Ann Clin Biochem 2020; 57:99-101. [DOI: 10.1177/0004563219884960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gynaecomastia is a common finding which typically appears during puberty in boys and in elderly males. At these times, gynaecomastia is likely to be due to physiological hormonal fluctuations, although there are a number of other causes including medications which must also be considered. We present a case of a 52-year-old male with gynaecomastia, hypogonadotropic hypogonadism and hyperoestrogenaemia. MRI of the adrenals confirmed the presence of an adrenocortical carcinoma, which after preoperative hormone workup was diagnosed as a feminizing adrenal tumour. The lesion was excised, and adjunct Mitotane therapy was commenced. Hyperoestrogenaemia is often secondary to exogenous testosterone administration; however, in the presence of hypogonadotropic hypogonadism, other sources of oestrogen should be sought. This case highlights a rare, but nonetheless important cause of gynaecomastia.
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Affiliation(s)
- Stephen M Gibbons
- SAS Steroid Centre, Specialist Laboratory Medicine, St James University Hospital, Leeds, UK
| | - Nuthar Jassam
- Biochemistry, Harrogate District Hospital, Harrogate, UK
| | - Afroze Abbas
- Endocrinology, Saint James University Hospital, Leeds, UK
| | - Kevin Stuart
- SAS Steroid Centre, Specialist Laboratory Medicine, St James University Hospital, Leeds, UK
| | - April Fairhurst
- SAS Steroid Centre, Specialist Laboratory Medicine, St James University Hospital, Leeds, UK
| | - Julian H Barth
- SAS Steroid Centre, Specialist Laboratory Medicine, St James University Hospital, Leeds, UK
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Verma P, Malhotra G, Kothari S, Jagtap R, Asopa RV. Increased F-FDG Uptake in Bilateral Gynecomastia Secondary to Feminizing Adrenal Tumor: A Rare Case Report and Review of Literature. Indian J Nucl Med 2017; 32:145-147. [PMID: 28533648 PMCID: PMC5439191 DOI: 10.4103/0972-3919.202246] [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: 11/12/2022] Open
Abstract
A 21 year old male who presented with painful enlargement of both the breasts and a hyperestrogenic state, was found to harbor a heterogeneous mass arising from the right adrenal on contrast enhanced Computed Tomography abdomen. The mass was hypermetabolic with no regional, nodal or distant metastases on Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography /Computed Tomography examination. Notably, substantial tracer uptake was seen in bilateral gynecomastia. The patient underwent a right adrenalectomy with the histopathology report confirming adrenocortical carcinoma. This case demonstrates utility of FDG PET/CT in adrenocortical carcinoma. However, when interpreting FDG PET/CT as a staging tool in oncological male patients, one should consider gynecomastia as a possible cause for increased FDG uptake in the breast as it may lead to a false positive interpretation.
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Affiliation(s)
- Priyanka Verma
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC Annexe, Jerbai Wadia Road, Parel, Mumbai, India
| | - Gaurav Malhotra
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC Annexe, Jerbai Wadia Road, Parel, Mumbai, India
| | | | - Rajlaxmi Jagtap
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC Annexe, Jerbai Wadia Road, Parel, Mumbai, India
| | - Ramesh V Asopa
- Radiation Medicine Centre, Bhabha Atomic Research Centre, TMC Annexe, Jerbai Wadia Road, Parel, Mumbai, India
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Feminizing adrenal tumor in a 6-year-old boy. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2016. [DOI: 10.1016/j.epag.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Feminizing adrenal tumors (FAT) are extremely rare tumors prevailing in males. Clinical manifestations are gynecomastia and/or other hypogonadism features in adults. They are rarer in pediatric population and their main manifestation is peripheral sexual precocity. In women genital bleeding, uterus hypertrophy, high blood pressure and/or abdomen mass may be the only manifestations. On the biological point, estrogen overproduction with or without increase in other adrenal hormones are the main abnormalities. Radiological examination usually shows the tumor, describes its limits and its eventual metastases. Adrenal and endocrine origins are confirmed by biochemical assessments and histology, but that one is unable to distinguish between benign and malignant tumors, except if metastases are already present. Immunostaining using anti-aromatase antibodies is the only tool that distinguishes FAT from other adrenocortical tumors. Abdominal surgery is the best and the first line treatment. For large tumors (≥10 cm), an open access is preferred to coeliosurgery, but for the small ones, or when the surgeon is experienced, endoscopic surgery seems to give excellent results. Surgery can be preceded by adrenolytic agents such as ortho paraprime dichloro diphenyl dichloroethane (Mitotane), ketoconazole or by aromatase inhibitors, but till now there is not any controlled study to compare the benefit of different drugs. New anti-estrogens can be used too, but their results need to be confirmed in malignant tumors resistant to classical chemotherapy and to conventional radiotherapy. Targeted therapy can be used too, as in other adrenocortical tumors, but the results need to be confirmed.
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Affiliation(s)
- Farida Chentli
- Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria
| | - Ilyes Bekkaye
- Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria
| | - Said Azzoug
- Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria
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