Gynecomastia Slide presentation & music composition by:

Dr. Seyed Reza Samsamshariat

Gynaecomastia means enlargement of the male breast

http://www.csisite.com/gynecomastia.html

There is increase of ductal structures and periductal stroma.

If the condition lasts for longer than a year the stroma becomes fibrous.

Other conditions causing male breast swelling like gynecomastia

Carcinoma Lipoma Neurofibroma

Neonatal

Puberty

Eldery

Ages in which gynecomastia is common (physiologic gynecomastia)

Pathophysiology of the gynocomastia

Unknown Decreased ratio of androgen to oesterogen

Hypersensitivity of the breast to hormones

70% of the male neonates have some breast enlargement.

Because hCG stimulates testis to produce estrogen.

Pubertal gynecomastia

Gynecomastia

Accompa-nied by prolactin raise

Raise in

oesteradiol

Treatment of the pubertal gynecomastia

Mild gynecomastia Usually regresses

Moderate to marked degrees

persistsTreated

with tamoxifen

Plastic surgery

Plastic surgery of the gynecomastia

http://www.google.com/imgres?imgurl=http://www.plasticsurgerypractice.com/content/PSP/2006/03/img/p7fig2.jpg&imgrefurl=http://www.plasticsurgerypractice.com/issues/articles/2006-03_07.asp&usg=__EUMRQejRqMy6SFUewtoFE0ztpHY=&h=203&w=225&sz=14&hl=en&start=18&zoom=1&tbnid=5HrSLIgsxKh70M:&tbnh=142&tbnw=157&ei=yfnLTZbdMpKq8APl4tmhBA&prev=/search%3Fq%3Dgynecomastia%2Bsurgery%26hl%3Den%26biw%3D1272%26bih%3D619%26gbv%3D2%26tbm%3Disch0%2C432&itbs=1&iact=hc&vpx=160&vpy=342&dur=57&hovh=162&hovw=180&tx=118&ty=85&page=2&ndsp=18&ved=1t:429,r:6,s:18&biw=1272&bih=619

Differential diagnosis of the physiologic pubertal gynecomastia

Side effect of some of the drugs

Testicular tumors

Senescent gynecomastia

Gynecomastia is associated

with

Hormone imbalance

s

Loss of libido

Flashing

Differential diagnosis of the physiologic senescent gynecomastia

Liver disease

Drug ingestion

Bronchogenic carcinoma

Testicular disorders causing gynecomastia

• Klinefelter’s syndrome

Hypogonadism

5% of the hyperthyroid males have gynecomastia

Hyperthyroidism

Affects liver

Excess conversion of androgen to estrogen

Gynecomastia

The adrenal diseases which

cause gynecomastia

Adrenocortical

carcinoma

Adenoma

Findings in adrenocortical carcinoma

Pituitary tumors with gynecomastia

Acidophil tumors

Chromophobe tumors

Mechanism by which pituitary tumors cause

gynecomastia •Prolactin secretion•Gonadotropin supression

Hypothalamic disorde

rs

•May give rise to precocious puberty &•Gynecomastia

Disorders of sex differentiationMale _pseudohermaphroditismhttp://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=-757385754

Testicular feminization syndromehttp://www.health-writings.com/klinefelter-turner-syndrome/

Gynecomastia in liver dysfunction

Decline in testosterone production

Increased conversion of androgen to estrogen

Increased sex hormone binding globulin (SHBG)

Neurological disorders causing

gynecomastia

Traumatic paraplegia

Dystrophia myotonica

Fredreich’s ataxia

Syringomyelia

Respiratory disorders with gynecomastia

Carcinoma of the bronchus• Produces hCG like hormone Chronic suppurative lung disease

Renal failure

Neoplasia

Congestive cardiac failure

Tuberculosis

cirrhosis

diabetes

Gynecomastia may occur in chronic debilitating diseases

Many drugs may cause

gynecomastia ( see the next

slide).

Drugs

Some of the drugs which’s side effect is gynecomastia

1-Hart. F Dudley. French’s index of differential dignosis. 12th Edition. wright Bristol. 1985. 315-319.2- Websites mentioned in the slides.

References: