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

2. Gynaecomastia means enlargement of the male breast http://www.csisite.com/gynecomastia.html

3. There is increase of ductal structures and periductal stroma. If the condition lasts for longer than a year the stroma becomes fibrous.

4. Other conditions causing male breast swelling like gynecomastia CarcinomaLipomaNeurofibroma

5. NeonatalPubertyEldery Ages in which gynecomastia is common (physiologic gynecomastia)

6. Pathophysiology of the gynocomastia Unknown Decreased ratio of androgen to oesterogen Hypersensitivity of the breast to hormones

7. 70% of the male neonates have some breast enlargement. Because hCG stimulates testis to produce estrogen.

8. Pubertal gynecomastia Gynecomastia Accompa- nied by prolactin raise Raise in oesteradiol

9. Treatment of the pubertal gynecomastia Mild gynecomastia Usually regresses Moderate to marked degrees persists Treated with tamoxifen Plastic surgery

10. 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&hov h=162&hovw=180&tx=118&ty=85&page=2&ndsp=18&ved=1t:429,r:6,s:18&biw=1272&bih=619

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

12. Gynecomastia is associated with Hormone imbalances Loss of libido Flashing

13. Liver diseaseDrug ingestion Bronchogenic carcinoma

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

15. 5% of the hyperthyroid males have gynecomastia HyperthyroidismAffects liver Excess conversion of androgen to estrogen Gynecomastia

16. The adrenal diseases which cause gynecomastia Adrenocortical carcinoma Adenoma

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

18. Pituitary tumors with gynecomastia Acidophil tumors Chromophobe tumors

19. Mechanism by which pituitary tumors cause gynecomastia Prolactin secretion Gonadotropin supression

20. May give rise to precocious puberty & Gynecomastia Hypothalamic disorders

21. Disorders of sex differentiation Male _pseudohermaphroditism http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID =-757385754 Testicular feminization syndrome http://www.health-writings.com/klinefelter-turner-syndrome/

22. Gynecomastia in liver dysfunction Decline in testosterone production Increased conversion of androgen to estrogen Increased sex hormone binding globulin (SHBG)

23. Neurological disorders causing gynecomastia Traumatic paraplegia Dystrophia myotonica Fredreich’s ataxia Syringomyelia

24. Respiratory disorders with gynecomastia Carcinoma of the bronchus Produces hCG like hormone Chronic suppurative lung disease

25. Renal failureNeoplasiaCongestive cardiac failureTuberculosiscirrhosisdiabetes Gynecomastia may occur in chronic debilitating diseases

26. Many drugs may cause gynecomastia ( see the next slide). Drugs

27. Some of the drugs which’s side effect is gynecomastia

28. 1-Hart. F Dudley. French’s index of differential dignosis. 12 th Edition. wright Bristol. 1985. 315-319. 2- Websites mentioned in the slides. References: