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Gynaecomastia

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Gynaecomastia is a benign enlargement of one or both breasts in men.

VOL: 101, ISSUE: 43, PAGE NO: 25

 

It is a common clinical condition and results from an imbalance in oestrogen and androgen action in the breast tissue.

Prevalence

- 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.

Physiological Causes

- Neonatal.

- Pubertal.

- Ageing.

Pathological Causes

- XXY males.

- Congenital anorchia.

- Testicular trauma or tumours.

- Viral orchitis.

- Hypopituitarism.

- Renal failure.

- Androgen insensitivity syndrome.

- Five alpha-reductase deficiency syndrome.

- Chronic liver disease.

- Hyperthyroidism.

- 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.

- Idiopathic.

Management

- 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.

Cancer risk

- 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.

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