How Effective Is Tamoxifen for Gynecomastia?
Gynecomastia is a common clinical disease. It is generally believed that in addition to 3 cases of males: transient mammary glands in newborns, enlarged mammary glands during puberty, and occasionally hyperplasia of mammary glands in older men, touching breast tissue is considered abnormal.
Basic Information
- English name
- gynecomastia
- Visiting department
- Endocrinology
- Common causes
- Increased estrogen secretion and decreased androgen / estrogen ratio
- Common symptoms
- Appearance of breast tissue, nipples, and areola
Causes of male breast development
- Male mammary gland development is due to increased estrogen secretion or decreased androgen / estrogen ratio. Excessive estrogen is the main cause of breast development in men. Exogenous estrogen preparations for men, such as prostate cancer patients with estrogen treatment, long-term use of estrogen in transsexual men and excessive secretion of estrogen by adrenal or testicular tumors Can cause breast hyperplasia.
Clinical manifestations of male breast development
- Men can have unilateral or bilateral palpable mammary glands, which are discoid nodules or diffusely enlarged, sometimes accompanied by enlarged nipples and areolas. Partial sensation can be pain or discomfort or tenderness. A few patients can see a small amount of white secretion overflow when they squeeze the nipple. The pathological male mammary gland development caused by organic diseases should also have clinical manifestations of primary disease.
Gynecomastia test
- Laboratory inspection
- (1) Determination of gonadotropin and gonadotropin can help diagnose whether there are primary or secondary testicular hypofunction.
- (2) Liver and kidney function tests can help diagnose liver and kidney failure.
- (3) Determination of cortisol, ACTH, 17-OHP, and hematuria cortisol can be used to evaluate congenital adrenal hyperplasia.
- 2. Other auxiliary inspections
- (1) B-ultrasound and mammography can distinguish between fat and breast tissue, and exclude breast cancer in time.
- (2) Pathological examination of breast tissue Further diagnosis.
Diagnosis of male breast development
- The first step is to determine if the breast tissue is genuine. The development of male mammary glands should be a solid piece of mammary gland under the palpable areola. The base is free and the diameter is> 2 cm. Lipomastia is common in obese men and looks like breast development, but without glandular tissue. Mammography or ultrasound can distinguish between fat and breast tissue. Followed by the exclusion of breast cancer, breast cancer is very rare in men. The frequency of male breast development is slightly higher than that of normal men, and the incidence is about 0.4%. If the surface of the breast tissue is not smooth, the growth is irregular, and the texture is hard, it often indicates early canceration, and the local appearance of ulcers or adjacent lymph node enlargement is the manifestation of advanced breast cancer. Mammography or biopsy should be performed to confirm the diagnosis.
Differential diagnosis of male breast development
- Knowing the patient's medication history can help determine the cause of mammary gland development in men. The physical examination includes secondary sexual characteristics, testes, and body type, and the determination of sex hormones and gonadotropins can help diagnose primary or secondary testicular dysfunction. Liver and kidney tests help diagnose liver and kidney failure. Cortisol, ACTH, 17-OHP, and urinary cortisol measurements can rule out congenital adrenal hyperplasia. If the results of the above tests are normal, it can be diagnosed as idiopathic male breast development.
Gynecomastia Treatment
- 1. 200mg dihydrotestosterone heptanoate, intramuscular injection every 3 to 4 weeks.
- 2. Tamoxifen (tamoxifen) can bind to the estrogen receptor of the target tissue and block the effect of estrogen.
- 3. The mechanism of action of clomiphene is similar to tamoxifen.
- 4. Testosterone lactone inhibits aromatase and blocks the conversion of testosterone into E2 in the periphery.
- 5. Mammoplasty Due to the irreversibility of long-term delay in men with mammary gland development, mammoplasty is still an important method to treat this disease. The ring areola approach is generally used to remove breast tissue under the areola.