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GYNECOMASTIA

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abdelrahman elneanaey

on 30 December 2013

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Transcript of GYNECOMASTIA

Gynecomastia
Other causes
NAME : Abdelrhman elneanaey

NUM : 619


GYNECOMASTIA
Diagnosis

Mammography
is the method of
choice for radiologic examination of
male breast tissue in the diagnosis of gynecomastia.

Differential diagnosis
Gynecomastia should
be distinguished from muscle
hypertrophy of the pectoralis
muscles.


Pathologic examination
of patients
has recently been questioned due to
the rarity of breast cancer in
this population.
Clinical Classification
Grading system:-

• Grade I: Minor enlargement, no skin excess

• Grade II: Moderate enlargement, no skin excess

• Grade III: Moderate enlargement, skin excess

• Grade IV: Marked enlargement, skin excess

- About 10%-25% of cases
result from the use of medications.
This is known as non-physiologic
gynecomastia .Those
medications
include:
GnRH analogues ,HGH , HCG.
Antiandrogens
5-alpha-reductase

inhibitors such as finasteride .


CAUSES
- Gynecomastia is caused by
excessive estrogen actions and is often the result of an
increased ratio of estrogen to androgen
.
- In approximately
25%
of cases, the cause of gynecomastia is
unknown
.
Microscopic features
Histological examination of tissue attained by fine needle aspiration cytology may demonstrate
dilated ducts with periductal fibrosis, increased subareolar fat, and hyalinization of the stroma
.
Gynecomastia is derived
from two terms
the term of gyneco which means the femal and the other term of mastia which means the breast.


- Also it may occurs in
older males

Signs and symptoms

- It occur unilaterally or
bilaterally . patient may have :
Swelling
Pain
Tenderness
Nipple discharge in one or
both breasts
Increase in the diameter
of the areola
Hypogonadism
Conditions that interfere with
normal testosterone production,
such as
Klinefelter syndrome

pituitary insufficiency
can be associated with
gynecomastia.
Aging
Normal aging cause hormone changes such as testosterone.
This is also known as
senile gynecomastia
and is typically found in men between
(60-80)
.
Endocrine tumors
- Other tumors such as
Adrenocortical tumors
Pituitary gland tumors
Bronchogenic carcinoma alters
the male-female hormone
balance.
Liver failure and cirrhosis
One of the most common cause
of gynecomastia .
The liver's ability to metabolize estrogen
is impaired.
Presence of phytoestrogens in alcohol may also cause a higher estrogen to testosterone ratio.
Those with alcoholic liver disease are put
at risk for development of gynecomastia .
Ethanol may disrupt the synthesis
of testosterone
Malnutrition and starvation
- Malnutrition cause :
testosterone levels drop .
the liver's ability to degrade estrogen
is diminished .
Hormonal imbalance.

Hyperthyroidism

10-40% of individuals with hyperthyroidism may experience gynecomastia .

Returning to a normal thyroid state leads to resolution of the
gynecomastia within
a few months.
Kidney failure

- Dialysis may attenuate
malnutrition of renal failure.

Prognosis
Weight loss can alter the condition, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss.
Thank
You

Gynecomastia commonly presents in
newborns
,
adolescents
, and
men
( 50 ).
REFERENCES
^ Jump up to: a b c Niewoehner, CB; Schorer, AE (March 2008). "Gynaecomastia and breast cancer in men". BMJ 336 (7646): 709–713. doi:10.1136/bmj.39511.493391.BE. PMC 2276281. PMID 18369226.
^ Jump up to: a b c d Shulman, DI; Francis, GL; Palmert, MR; Eugster, EA; Lawson Wilkins Pediatric Endocrine Society Drug and Therapeutics Committee (April 2008). "Use of aromatase inhibitors in children and adolescents with disorders of growth and adolescent development.". Pediatrics 121 (4): e975–983. doi:10.1542/peds.2007-2081. PMID 18381525.
http://en.wikipedia.org/wiki/Gynecomastia#Epidemiology
Jump up ^ Iaunow, E; Kettler, M; Slanetz, PJ (March 2011). "Spectrum of disease in the male breast". American Journal of Roentgenology 196 (3): W247–259. doi:10.2214/AJR.09.3994. PMID 21343472.
http://www.mayoclinic.com/health/gynecomastia/DS00850/DSECTION=causes
Introduction
Thyroid gland produces too
much of thyroxine and is thought
to influence the level of sex hormone binding globulin.
- Malabsorption conditions such
as cystic fibrosis or
ulcerative colitis .
- Gynecomastia can occur once normal nutrition resumes but usually resolves
within one to two years.
- Testicular tumors such as
Leydig cell tumors .
Sertoli cell tumors .
HCG-secreting choriocarcinoma .
- Renal failure cause
Malnutrition
Hormonal imbalance
Suppression of testosterone
Testicular damage from high levels of urea
uremia-associated hypogonadism
.
Growing glandular tissue by act of hormonal stimulation, is often tender or painful.
It can frequently present social and psychological difficulties.
- Gynecomastia
is the
benign enlargement of
breast tissue in males.
- It may occur transiently in newborns .
- Half or more of adolescent boys have some breast development during puberty.
- Other probable Medications include :
CCB
such as nifedipine,
Anabolic steroids , alcoholics.
Opioids, alkylating agents .
Androgen deprivation therapy .
Gynecomastia is not harmful , but in
some cases it may be an indicator
testicular cancer.
Massive weight loss can result in sagging tissues chest ptosis.
(30-60 %) male may exhibit sign of gynecomastia during their adolescence.
Most cases of adolescent gynecomastia resolve within six months to two years.
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