Gynecomastia Slide presentation & music composition by: Dr. Seyed Reza Samsamshariat

Gynaecomastia means enlargement of the male breast

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 CarcinomaLipomaNeurofibroma

NeonatalPubertyEldery 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 persists Treated with tamoxifen Plastic surgery

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Differential diagnosis of the physiologic pubertal gynecomastia Side effect of some of the drugs Testicular tumors

Gynecomastia is associated with Hormone imbalances Loss of libido Flashing

Liver diseaseDrug ingestion Bronchogenic carcinoma

Testicular disorders causing gynecomastia Klinefelter’s syndrome Hypogonadism Leydig cell tumor Choriocarcinoma Tumors Mump Leprosy Infections (rarely)

5% of the hyperthyroid males have gynecomastia HyperthyroidismAffects liver Excess conversion of androgen to estrogen Gynecomastia

The adrenal diseases which cause gynecomastia Adrenocortical carcinoma Adenoma

Findings in adrenocortical carcinoma Testicles small azospermia Hypoplasia of the Leydig cells Gonadotrophin level Suppressed Estrogen may be raised In plasmaIn urine

Pituitary tumors with gynecomastia Acidophil tumors Chromophobe tumors

Mechanism by which pituitary tumors cause gynecomastia Prolactin secretion Gonadotropin supression

May give rise to precocious puberty & Gynecomastia Hypothalamic disorders

Disorders of sex differentiation Male _pseudohermaphroditism = Testicular feminization 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 failureNeoplasiaCongestive cardiac failureTuberculosiscirrhosisdiabetes 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. 12 th Edition. wright Bristol Websites mentioned in the slides. References: