Why does gynecomastia occur in liver disease

Incidence of gynaecomastia in young males and its relationship to somatometric parameters. Ann Hum Biol. Beneficial effects of raloxifene and tamoxifen in the treatment of pubertal gynecomastia. J Pediatr. Hormonal studies and physical maturation in adolescent gynecomastia. Pubertal gynecomastia and transient elevation of serum estradiol level. Am J Dis Child. Gynecomastia in a hospitalized male population. Am J Med. Drug-induced gynecomastia. Eckman A, Dobs A. Expert Opin Drug Saf. Antipsychotic medication in children and adolescents: a descriptive review of the effects on prolactin level and associated side effects.

J Child Adolesc Psychopharmacol. The effect of low-dose spironolactone on resistant hypertension. J Am Soc Hypertens. A systematic review and economic evaluation of the clinical effectiveness and cost-effectiveness of aldosterone antagonists for postmyocardial infarction heart failure.

Health Technol Assess. Prepubertal gynecomastia linked to lavender and tea tree oils. Singapore Med J. Messina M. Soybean isoflavone exposure does not have feminizing effects on men: a critical examination of the clinical evidence.

Fertil Steril. Gynaecomastia linked to the intake of a herbal supplement fortified with diethylstillbestrol. Basaria S. Androgen abuse in athletes: detection and consequences. J Clin Endocrinol Metab. Klinefelter syndrome and other sex chromosomal aneuploidies. Orphanet J Rare Dis. Testicular tumour presenting as gynaecomastia. Testicular tumours presenting as gynaecomastia.

Eur J Surg Oncol. Muthusamy E. Hyperthyroidism with gynaecomastia, galactorrhoea and periodic paralysis. Gynecomastia and hyperthyroidism. An endocrine and histological investigation. Gonadal dysfunction in men with chronic kidney disease: clinical features, prognostic implications and therapeutic options. J Nephrol. Mehrotra R, Kopple JD.

Nutritional management of maintenance dialysis patients: why aren't we doing better? Annu Rev Nutr. Leptin levels in boys with pubertal gynecomastia.

J Pediatr Endocrinol Metab. Unilateral pseudogynecomastia: an occupational hazard in manual metal-pressing factories? Aesthetic Plast Surg. Plasma phthalate levels in pubertal gynecomastia. Internal exposures to pollutants and sexual maturation in Flemish adolescents.

J Expo Sci Environ Epidemiol. Treatment of adolescent gynecomastia. J Pediatr Surg. Laser lipolysis with pulsed nm Nd:YAG laser for the treatment of gynecomastia. Int J Dermatol. Gynecomastia as a first clinical sign of nonseminomatous germ cell tumor. Urol Int.

Mammography and ultrasound in the evaluation of male breast disease. Eur Radiol. Etiologic factors for male breast cancer in the U. Veterans Affairs medical care system database. Breast Cancer Res Treat. The role of tamoxifen in the management of gynaecomastia.

J Urol. Treatment of gynecomastia with tamoxifen: a double-blind crossover study. Tamoxifen therapy for painful idiopathic gynecomastia. South Med J. Tamoxifen as prophylaxis for prevention of gynaecomastia and breast pain associated with bicalutamide mg monotherapy in patients with prostate cancer: a randomised, placebo-controlled, dose-response study.

Eur Urol. An open, randomised, multi-centre, phase 3 trial comparing the efficacy of two tamoxifen schedules in preventing gynaecomastia induced by bicalutamide monotherapy in prostate cancer patients. Pharmacokinetics and pharmacodynamics of anastrozole in pubertal boys with recent-onset gynecomastia. Safety and efficacy of anastrozole for the treatment of pubertal gynecomastia: a randomized, double-blind, placebo-controlled trial.

Surgical correction of gynecomastia in thin patients. Indications for and results of surgical therapy for male gynecomastia. Ceasing to use the offending agent may result in regression of GM. If GM either persists or becomes more severe and is associated with pain, psychological distress or embarrassment caused by avoidance of activities in which the chest is exposed, pharmacological and surgical therapeutic options should be considered, especially when the patient wishes to pursue treatment.

With the assumption that there is a high possibility that the GM may spontaneously regress, the decision on when to treat is often difficult. Androgens, antiestrogens and aromatase inhibitors have been tested for GM treatment with some success. Danazol is an antigonadotropic drug with a weak androgen effect that acts to counterbalance the stimulatory effects of estrogens. A daily dose of mg may provide effective control over the symptoms.

Dihydrotestosterone heptanoate, which does not undergo peripheral aromatization, was used in one study for a small number of pubertal cases with excellent results.

Selective estrogen receptor modulators, such as tamoxifen and raloxifene are fairly safe and should be beneficial. Two studies have compared tamoxifen with other substances. Ting et al. Three studies have investigated the effectiveness of anastrozole, which is a potent aromatase inhibitor used for treating pubertal GM.

While two observational studies with small samples have provided encouragement for the use of anastrozole, 66,67 a well-designed randomized controlled trial on 80 pubertal boys found that anastrozole was not significantly more effective than placebo for reducing the breast volume calculated from ultrasonography measurements Tamoxifen was considered superior to anastrozole for prevention of bicalutamide-induced GM in men with prostate cancer.

Overall, the use of drugs for GM treatment is only supported by very low quality of evidence, and the uncertainty about the balance between their benefits and potential harm should be highlighted to candidate patients. GM of long duration is unlikely to regress spontaneously and may often progress to dense fibrosis and hyalinization.

So far, for long-standing symptomatic GM, medical therapy is less likely to be effective because the stroma is mostly fibrotic. Traditionally, surgery has been the mainstay of therapy in such cases, as well as for men for whom medical therapy fails, is not tolerated or is declined, or for whom tissue removal is preferable for cosmetic reasons.

In some cases, denial of cosmetic correction or procrastination in providing this may create an additional unnecessary burden on an already overloaded psyche. The aims of surgical treatment of GM are to restore normal chest contours, eliminate the inframammary fold, correct the NAC position, remove redundant skin, create symmetry between the two halves of the chest and minimize scarring.

There are many surgical techniques and treatment protocols for correcting GM in the literature. The presence of cutaneous ptosis and the amount of excessive skin are decisive in guiding the choice between surgical treatment methods.

In our opinion liposuction alone should not be used and is limited only to cases of pure pseudogynecomastia. Surgical treatment of gynecomastia requires an individualized approach. In grade I, the enlargement is caused solely by glandular proliferation without adipose accumulation. Surgical correction involves mammary adenectomy performed by a semicircular inferior periareolar incision. Liposuction is not required Figure 6. In these cases, liposuction and surgical excision must be combined in the same operation Figure 7.

We recommend that the procedure should begin with vacuum lipoplasty and should be followed by mammary adenectomy by means of a classical periareolar incision. It is worth noting that other incisions may also allow good results, such as intra-areolar, pull-through or endoscopic procedures. Mammary adenectomy without liposuction leads to unsatisfactory outcomes, with an uneven surface or asymmetry.

In grade III, the operation begins with liposuction and is followed by glandular excision with periareolar removal of the tissue. It is necessary to detach the excess skin to obtain a good chest silhouette.

The surgical planning is undertaken bearing in mind the necessity to preclude the stigma of big scars. For the final appearance, it is always preferable for the scars to be restricted to the periareolar area. As a routine, a double-circle incision is performed over the skin, thereby making it possible to remove the epithelial tissue from an annular portion of skin that is as large as needed for each case Figure 8.

Because the epidermis has been removed, round-black suturing is done, which gives rise to a circumferential periareolar scar. The hallmarks of grade IV GM are severe ptosis and a large amount of redundant skin. One of the techniques for reduction mastoplasty is used to remove gland and skin and flatten the chest outline. Inverted T-shaped resection, with NAC migration using superior or superior-medial dermic pedicles, similarly to the procedure for mammoplasty in women, may be used.

Other techniques such as those with horizontal or oblique incisions can also be used Figure 9. When patients strongly desire to have inconspicuous scars confined to the periareolar region, sequential double-circle skin incisions in a multi-step procedure are a valid option.

Since GM may be harboring neoplasia, histopathological analysis of the resected tissue is mandatory. Closed suction drains are placed after the excisions and removed when the output over 24 hours has decreased to less than 30 ml. To facilitate tissue accommodation and achieve an even chest surface, we advise patients to wear elastic compressive garments for a period of months.

Hypoesthesia of the nipple is very common and is transient. The cosmetic results and patient satisfaction after surgery are high. After confirming the diagnosis, searching for a specific cause and classifying the case according to severity grade, the therapy for GM should be personalized. Lifestyle guidance, reassurance, medical treatment and surgical correction are valid tailored therapeutic options.

Abrir menu Brasil. Sao Paulo Medical Journal. Abrir menu. Breast; Gynecomastia; Surgery; Adolescent; Endocrine system diseases. Key words: Breast. Endocrine system diseases. Palavras-chave: Mama. Incidence of gynaecomastia in young males and its relationship to somatometric parameters.

Ann Hum Biol. Nuttall FQ. Gynecomastia as a physical finding in normal men. J Clin Endocrinol Metab. Gynecomastia in adolescent boys. Gynecomastia in a hospitalized male population. Am J Med. Gynecomastia: clinicopathologic study of cases. Am J Clin Pathol. Moore NP. The oestrogenic potential of the phthalate esters. Reprod Toxicol. Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev. Aromatase and steroid receptors in gynecomastia and male breast carcinoma: an immunohistochemical study.

J Clin Endocrinol Metabol. Measurement of androgen and estrogen receptors in breast tissue from subjects with anabolic steroid-dependent gynecomastia.

Life Sci. Adolescent gynecomastia: not only an obesity issue. Ann Plast Surg. A physiologic role for testosterone in limiting estrogenic stimulation of the breast.

Pearlman G, Carlson HE. Gynecomastia: an update. Key points about gynecomastia Gynecomastia is an overdevelopment or enlargement of the breast tissue in men or boys.

They often grow unevenly. It is often caused by changes in levels of the female hormone estrogen and the male hormone testosterone. Other things may cause it as well. Most cases happen when a preteen or teenage boy is going through puberty. But it can also happen to newborn babies and older men. It often goes away on its own. In some cases, hormone therapy is needed. Surgery may also help treat the condition.

Next steps Tips to help you get the most from a visit to your healthcare provider: Know the reason for your visit and what you want to happen. Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells you. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed, and how it will help you. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Fentiman IS. Managing male mammary maladies. European Journal of Breast Health. Braunstein GD, et al. Epidemiology, pathophysiology, and causes of gynecomastia. Accessed Aug.

Sansone A, et al. Gynecomastia and hormones. Jameson JL, et al. Disorders of the testes and male reproductive system. In: Harrison's Principles of Internal Medicine. The McGraw-Hill Companies;