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GynecomastiaAka: Male Breast Enlargement, Benign Gynecomastia of Adolescence, Familial Gynecomastia

See Also
1. Precocious Puberty
Physiologic Cause in Newborn, Puberty, Older men
1. Physiologic Mechanisms
  1. Estrogen excess
  2. Decreased androgen to Estrogen ratio
2. Physiologic syndromes
  1. Gynecomastia in the newborn
    1. Common response to maternal Estrogens
    2. Breast enlargement usually resolves in weeks
    3. May be accompanied by milk discharge (witch's milk)
  2. Benign Gynecomastia of Adolescence
    1. Frequently occurs in boys at mid to late Puberty
    2. Asymmetric breast involvement and tenderness
    3. Resolves spontaneously within 1-2 years
  3. Familial Gynecomastia
    1. Common X-Linked recessive or dominant trait
    2. Limited breast development during Puberty
    3. No further evaluation unless Hypogonadism present
  4. Gynecomastia of aging
    1. Common in men over age 65 years (40-72%)
    2. Decreased androgen to Estrogen ratio
Medication causes
1. Cimetidine
2. Spironolactone
3. Nifedipine
4. Verapamil
5. Chemotherapeutics
6. Phenothiazine
7. Topical Estrogen exposure from sexual partner
Illicit Drug use
1. Male bodybuilder Tamoxifen use
2. Anabolic Steroids
3. Heroin
4. Marijuana
5. Methadone
Other Pathologic causes
1. Renal Failure
2. Hyperthyroidism
3. Congenital anorchia
4. Klinefelter's Syndrome
5. Primary tumor
  1. Adrenal tumor
  2. Testicular tumor
  3. Prolactin-secreting adenomas
6. Ectopic hormone production
  1. Lung Cancer
  2. Stomach Cancer
  3. Liver cancer
  4. Kidney cancer
References
1. Wilson (1998) Williams Endocrinology, Saunders, 885-92
2. Braunstein (1993) N Engl J Med 328:490
3. Sher (1998) Clin Pediatr 37(6):367

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This page was written by Scott Moses, MD. This page was last revised on 4/26/2008 9:10:47 PM. This page was last published on 4/29/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.