Gynecomastia

Gynecomastia facts

Gynecomastia is enlargement of the glandular tissue of the male breast.

Gynecomastia may occur during infancy and puberty in normally-developing boys.

Gynecomastia results from an imbalance in the hormonal environment in the body, with a relative excess of estrogens (female hormones) when compared to androgens (male hormones).

Gynecomastia can result as a side effect of numerous medications and drugs of abuse.

Gynecomastia is associated with certain medical conditions including hyperthyroidism, chronic kidney failure, and cirrhosis of the liver.

Medications and surgical treatments can be used to treat gynecomastia.

What is gynecomastia?

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Gynecomastia is enlargement of the gland tissue of the male breast. During infancy, puberty, and in middle-aged to older men, gynecomastia can be common. Gynecomastia must be distinguished from pseudogynecomastia or lipomastia, which refers to the presence of fat deposits in the breast area of obese men. True gynecomastia results from growth of the glandular, or breast tissue, which is present in very small amounts in men. Gynecomastia is the most common reason for medical evaluation of the male breast.

What causes gynecomastia?

Gynecomastia results from an imbalance in hormone levels in which levels of estrogen (female hormones) are increased relative to levels of androgens (male hormones). Gynecomastia that occurs in normally-growing infant and pubertal boys that resolves on its own with time is known as physiologic gynecomastia.

All individuals, whether male or female, possess both female hormones (estrogens) and male hormones (androgens). During puberty, levels of these hormones may fluctuate and rise at different levels, resulting in a temporary state in which estrogen concentration is relatively high. Studies regarding the prevalence of gynecomastia in normal adolescents have yielded widely varying results, with prevalence estimates as low as 4% and as high as 69% of adolescent boys. These differences probably result from variations in what is perceived to be normal and the different ages of boys examined in the studies.

Gynecomastia caused by transient changes in hormone levels with growth usually disappears on its own within six months to two years. Occasionally, gynecomastia that develops in puberty persists beyond two years and is referred to as persistent pubertal gynecomastia.

A number of medical conditions may also result in gynecomastia:

Malnutrition and re-feeding (recovery from malnutrition) have both been shown to create a hormonal environment that may lead to gynecomastia. Similarly, cirrhosis of the liver alters normal hormone metabolism and may lead to gynecomastia.

Disorders of the male sex organs (testes) can result in decreased testosterone production and relatively high estrogen levels, leading to gynecomastia. These disorders may be genetic, such as Klinefelter's syndrome, or acquired due to trauma, infection, reduced blood flow, or aging. Testicular cancers may also secrete hormones that cause gynecomastia.

Other conditions that are associated with an altered hormonal environment in the body and may be associated with gynecomastia are chronic renal failure and hyperthyroidism. Rarely, cancers other than testicular tumors may produce hormones that can cause gynecomastia.

Gynecomastia can also be a side effect of a number of medications. Examples of drugs that can be associated with gynecomastia are listed below:

spironolactone (Aldactone), a diuretic that has anti-androgenic activity:

Calcium channel blockers used to treat hypertension (such as nifedipine [Procardia and others]):

ACE inhibitor drugs for hypertension (captopril [Capoten], enalapril [Vasotec]):

some antibiotics (for example, isoniazid, ketoconazole [Nizoral, Extina, Xolegel, Kuric], and metronidazole [Flagyl])

anti-ulcer drugs (such as ranitidine [Zantac], cimetidine [Tagamet], and omeprazole [Prilosec])

anti-androgen or estrogen therapies for prostate cancer

methyldopa (Aldomet)

highly active anti-retroviral therapy (HAART) for HIV disease, which may cause fat redistribution leading to pseudogynecomastia or, in some cases, true gynecomastia

digitoxin

diazepam (Valium)

drugs of abuse (for example, alcohol, marijuana, heroin) and

lavender oil and tea tree oil, when used in skin-care products, have been associated with gynecomastia.

If you have been diagnosed with central diabetes insipidus,

There are some things you should know about how the disorder is caused and what you and your doctor can do about it.

What causes it?

In central diabetes insipidus, the antidiuretic hormone vasopressin is either missing or present at a low level. This low level or lack of vasopressin is due to a malfunction in the part of your brain, the posterior pituitary gland, which releases the hormone into your bloodstream. Injury to the head, tumors, neurosurgical operations, infections, or bleeding can affect your brain's ability to release the right amount of vasopressin.

What are the symptoms?

excessive urination (polyuria) which is followed by excessive thirst (polydipsia)

Patients with central diabetes insipidus are often extremely tired because they cannot get enough sleep uninterrupted by the need to urinate. Their urine is very clear and odorless. These symptoms can appear at any time. Because they lose so much water from urination, they also feel very thirsty. If this disorder is untreated, they could become seriously dehydrated, and their bodies will not have enough water to function properly.

Nephrogenic diabetes insipidus

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Nephrogenic diabetes insipidus is much less common than central diabetes insipidus. If you have been diagnosed with nephrogenic diabetes insipidus, your doctor or nurse will discuss the disorder and its treatment with you. They will be happy to answer your questions.

What causes it?

Nephrogenic diabetes insipidus may be caused by kidney diseases that make the kidneys unable to respond to vasopressin. While there is enough vasopressin in the body (unlike in central diabetes insipidus), the kidneys cannot respond to the hormone's signal to reabsorb water. The disease may be acquired or inherited by male children.

What are the symptoms?

The symptoms of nephrogenic diabetes insipidus are similar to central diabetes insipidus; that is, excessive urination (polyuria) followed by excessive thirst (polydipsia).

How is it treated?

The first step in treating this disease is correct diagnosis. In addition to the medications available, balancing your water or fluid intake with your urine output is also part of treatment. If this disorder is untreated, you could become seriously dehydrated, and your body will not have enough water to function. Patient Information Publications 2 Diabetes Insipidus

What tests can find out if I have central diabetes insipidus or nephrogenic diabetes insipidus?

The two most common tests used to diagnose diabetes insipidus are the following:

Water deprivation test/vasopressin test

Hypertonic saline infusion test.

Other tests which may be used are the urine specific gravity test and the serum or urine osmolality test. These tests measure the concentration of solid particles in your urine. Patients with diabetes insipidus have urine with fewer solids than that of people without the disease.

With the water deprivation test, you will be asked not to drink any fluids. Your doctor will tell you how long you must abstain from drinking. Then, laboratory tests will be done to show any change in the amount and concentration of particles in your urine.

The vasopressin test is done if the water deprivation test does not result in sufficiently concentrated urine. Vasopressin is given by the doctor or nurse by injection to test your body's reaction to the hormone.

During the hypertonic saline infusion test, you will receive a mixture of salt and water by intravenous infusion. Your doctor or nurse will then draw blood from you which will be tested for osmolality and vasopressin content.

The serum or urine osmolality test is done to find out the concentration of particles in your blood or urine.

The urine specific gravity test is also a way to find out the concentration of solid particles in urine. Patients with diabetes insipidus have fewer particles in urine, so their specific gravity measurements will be below normal.

What is the therapy for central diabetes insipidus?

If you are treated for central diabetes insipidus, you will sniff a drug called DDAVP (Desmopressin), a derivative of vasopressin. You will be shown the right way to use this drug by your physician, nurse, or pharmacist.

What is the therapy for nephrogenic diabetes insipidus?

If you have nephrogenic diabetes insipidus, water pills (thiazide diuretics) may be prescribed by your doctor. You may be confused as to why you need to take diuretics for this disorder. Thiazide diuretics have been shown to stimulate the production of a hormone that helps your body retain salt. This added amount of salt keeps you from losing too much water.

And of course, always feel free to ask your doctor or nurse any questions you have about your diagnosis and treatment.