Gynaecomastia is a benign enlargement of one or both breasts in men.
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It is a common clinical condition and results from an imbalance in oestrogen and androgen action in the breast tissue.
- It can be detected in up to 70 per cent of boys during puberty and between one-third and two-thirds of adult males (Braunstein, 1999).
- The nature of the condition may result in statistics regarding prevalence being unreliable. However, there is concern that the condition is increasing.
- This increase may be associated with increases in alcohol abuse and an increase in use of medication linked to the condition.
- XXY males.
- Congenital anorchia.
- Testicular trauma or tumours.
- Viral orchitis.
- Renal failure.
- Androgen insensitivity syndrome.
- Five alpha-reductase deficiency syndrome.
- Chronic liver disease.
- Adrenal tumours.
- Oestrogen, or drugs with oestrogen-like activity or that enhance oestrogen synthesis.
- Drugs that inhibit testosterone synthesis or action.
- Other medication such as methyldopa, tricyclic antidepressants, diazepam, ACE inhibitors.
- Excessive alcohol consumption.
- Marijuana and heroin use.
- Anabolic steroid use.
- Breast size of more than 5cm, a tender lump of recent onset or unknown duration, or that is progressive, or shows signs of malignancy, requires further investigation.
- Pubertal gynaecomastia resolves spontaneously in about 90 per cent of cases (Segu, 2005).
- Identifying and managing an underlying primary disorder often alleviates breast enlargement.
- For patients with idiopathic gynaecomastia or residual gynaecomastia after treatment of the primary cause, medical or surgical treatment may be considered.
- Drug therapy including: clomiphene, tamoxifen, danazol and testolactone.
- This condition, although not normally life-threatening in itself, can cause considerable emotional trauma and requires sensitive nursing care.
- A study by Olsson et al (2002) into links with gynaecomastia and carcinoma found no prospective cases of male breast cancer, although two had occurred prior to gynaecomastia diagnosis.
- Olsson et al also found skin cancer and oesophageal cancer were more common among men with gynaecomastia.
- The study confirmed an increased risk for testicular cancer in men with a history of gynaecomastia.