男性乳房发育ppt

Etiologies
▪ Drugs: 10-25% ▪ Idiopathic: 25% ▪ Persistent pubertal gynecomastia: 25% ▪ Cirrhosis or malnutrition: 8% ▪ Primary hypogonadism: 8% ▪ Testicular tumors: 3% ▪ Secondary Hypogonadism: 2% ▪ Hyperthyroidism: 1.5% ▪ Chronic renal insufficiency: 1%
Improves gynecomastia in hypogonadism No use in eugonadal men May worsen gynecomastia due to aromatization of testosterone to estradiol
▪ Dihydrotestosterone (nonaromatizable androgen)
Brian Lee, MD, 2nd Yr Internal Medicine Resident, Siriraj Hospital
topic review
Gynecomastia
Definition of Gynecomastia
True gynecomastia:
▪ benign enlargement of male breast due to proliferation glandular components
▪ Rubbery or firm mound of tissue that is concentric with the nipple-areolar complex is felt
Pseudogynecomastia / lipomastia: ▪ fat deposition without
glandular proliferation
Braunstein G. N Engl J Med 1993;328:490-495
How to approach
Gynecomastia
Interpretation of Serum Hormone Levels and Recommendations for Further Evaluation of Patients with ecomastia
Treatments
▪ Medications
May be indicated in patients with persistent gynecomastia, eg. Later puberty with severe pain, tenderness, psychosocial issues of embarrasment.
Braunstein G. N Engl J Med 2007;357:1229-1237
Treatment Options
▪ Watchful Waiting ▪ Medications ▪ Surgery
Treatments
▪ Watchful waiting
In healthy adolescent with normal physical exam, including genitalia, reevaluate in 6 months
▪ Three peaks ▪ Infancy: 60-90% . Due to high maternal estrogen. Normally regresses
over 2-3 week period. ▪ Adolescence: 48-64% . Peak at 13-14 yr. Normally regresses in 18 mo. ▪ Older men: 24-65%. Highest prevalence in 50-80 yr.
Gynecomastia attributed to a medication should be stopped and patient reassessed after stopping medication
Regression will occur in 85% of patients with gynecomastia due to various causes
Kronenberg: Williams Textbook of Endocrinology, 11th ed.
Glandular and Peripheral Origins and Interrelations of Testosterone, Androstenedione, Estrone, and Estradiol
Differentiation of Gynecomastia from Pseudogynecomastia and Other Disorders by Physical Examination
Braunstein G. N Engl J Med 2007;357:1229-1237
Prevalence
Three types of medications
Androgens, SERMS, aromatase inhibitors Limited clinical data None are FDA approved for gynecomastia
Androgens
▪ Testosterone
Harrison’s Principles of Internal Medicine, 17th Ed.
Kronenberg: Williams Textbook of Endocrinology, 11th ed.
Kronenberg: Williams Textbook of Endocrinology, 11th ed.
Idiopathic gynecomastia: decrease in breast volume in 75% of patients, resolution in 25%. No noted side effects; decrease in tenderness within 1-2 weeks.