Gynecomastia (translated from Greek - Hooters) - a benign increase in mammary (breast) gland in men. Dimensions formations in the breast may be within 1-10sm, but as a rule, do not exceed 4 cm in diameter.
Kinds
Distinguish Physiological and Pathological gynecomastia.
- The first peak physiological gynecomastia occurs in the neonatal period (60-80%) within a few days after birth. Gynecomastia is associated with this blood by circulating maternal estrogen, and runs independently, within 2-4 weeks.
- The second peak of the disease occurs in adolescence (12-14 years) and hormonal changes caused by the body. Adolescent gynecomastia disappears after 6-24 months without treatment.
- The third peak occurs in old age (men 50-80 years), it is associated with a decrease in testosterone levels and a relative hyperestrogenemia (elevated levels of female sex hormones).
Also distinguish between false and true gynecomastia.
- Misleading form of the disease develops due to proliferation of adipose tissue (e.g., in obesity or excessive enthusiasm beer).
- True gynecomastia - a proliferation of glandular and stromal tissue. May be affected as a single breast - one-sided gynecomastia, or both - of bilateral gynecomastia. Adolescents often observed two-way shape.
Causes
The causes of gynecomastia are very numerous. The first true gynecomastia is associated with hormonal imbalance (dominance of estrogen and / or a lack of androgens)
- congenital hypogonadism (testicular hypoplasia);
- toxic, radiation, or infection of the testicles;
- testicular tumor that produces estrogens;
- adrenal tumor (increased synthesis of estrogen);
- violation of the hypothalamus (part of the brain responsible for the formation of hormones);
- genetic diseases (Klinefelter Syndrome);
- hyperthyroidism (hyperthyroidism);
- liver diseases (cirrhosis) Which do not disintegrate estrogens;
- choriocarcinoma (a malignant tumor, synthesizing the pregnancy hormone - hCG);
- y-athletes men with abrupt cessation of physical activity;
- hyperprolactinemia;
- malnutrition or famine;
- kidney failure;
- HIV nfektsiya (the cause hyperprolactinaemia).
Additionally, gynecomastia may be a side effect when taking these drugs:
- spironolactone;
- calcium channel blockers (Corinfar, verapamil);
- antihypertensive drugs (capoten, enap);
- antibiotics and antifungals (metronidazole, ketoconazole);
- hormonal preparations for the treatment of prostate cancer;
- drugs and alcohol;
- cytostatics (methotrexate);
- antidepressants and anxiolytics (relanium).
symptoms of gynecomastia
For gynecomastia is characterized by the following clinical picture:
- breast or prostate increases in size, determined by palpation movable flexible education and tenderness of the breast,
- patients often complain of a sense of fullness or tightness in the chest, an increase in nipple (swelling) and their increased sensitivity,
- nipple possible transparent or cloudy discharge.
During gynecomastia distinguish three steps:
1. Developing (proliferating) step - lasts for about 4 months. In appointing the treatment of breast return to their original size.
2. The intermediate stage - lasts from 4 to 12 months. At this time the maturation of breast tissue and breast cancer is almost do not return to their previous size.
3. Fibrous step - is characterized by the appearance in the mammary gland mature connective tissue and the formation of fatty deposits around glandular tissue. Fibrotic stage is irreversible.
Diagnostics
In gynecomastia diagnosis using ultrasound breast, axillary lymph nodes, and mammograms and needle biopsy.
In addition, a laboratory diagnosis is determined by the level of hormones (testosterone, estradiol, Thyroid-stimulating hormone TSH, prolactin, hCG, Luteinizing hormone (LH) And follicle (FSH) Hormone).
If you suspect testicular tumors do ultrasound of the testes and the adrenal tumor is suspected - computed tomography.
Often, patients need to consult a surgeon, urologist, endocrinologist, and therapist.
gynecomastia treatment
Treatment of Gynecomastia engaged oncologists and endocrinologists mammologist.
The first step is to install and remove the cause that led to the disease. Depending on the etiology of gynecomastia vary and the treatment time (sometimes up to several months). When receiving the drugs, a side effect which was gynecomastia, they are sufficient to cancel or reduce the dose.
During the first six months of disease progression prefer to watch. If an independent regression of gynecomastia has not happened, appoint conservative hormonal therapy:
- Testosterone (treatment of patients with low levels of this hormone, the elderly);
- clomiphene - antiestrogen used to stimulate ovulation in female infertility;
- tamoxifen - estrogen receptor blocker (for severe disease and severe pain);
- Danazol - a synthetic analogue of testosterone.
Surgical treatment is conducted in patients with suspected malignant process and expressed cosmetic effect.
Implants involves the removal of the breast tissue to form a bed under the teat in order to prevent its retraction.
complications
The most severe complication of gynecomastia is a malignancy (degeneration into cancer) tumor. Also, do not exclude emotional disorders and scarring of the long-existing tumor.
Prevention and prognosis
Forecast for gynecomastia in newborns and adolescent-friendly (disease regress on their own). In other cases, the prognosis of the disease depends on the reasons why he had been summoned, and also remains favorable in the surgical treatment.
Prevention of gynecomastia is the leading healthy lifestyles, careful selection of drugs drugs, which led to the development of the disease, as well as in the prevention of the causes that can cause gynecomastia.
