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... d neck area may show signs of a pituitary tumor or goiter which is found in Graves disease. The skin and abdomen may reveal signs of liver failure and the testes should be examined for asymmetric enlargement in Klinefelter's syndrome. The doctor may consider liver function tests of a karyotype if Kleinfelter's is suspected. Other diseases related to gynecomastia include: testicular tumors, hypo and hyperthyroidism, Cushing's disease, cirrhosis, spinal cord lesions, Hodgkin's disease, enzymatic defects in androgen synthesis and androgen resistance syndromes, and many others. The evaluation of patients with gynecomastia should include a careful drug history, measurement and examination of the testes, evaluation of liver function and endocrine evaluation to include measurement of serum androstenedione or 24 -h urinary 17 -keto-serious, plasma estradiol and hCG, and plasma luteinizing hormone (LH) and test oster- one.
If LH is high and testosterone is low, the diagnosis is usually testicular failure. If LH and testosterone are both low, the diagnosis is usually increased estrogen production. If they are both high, the diagnosis is either an androgen-resistance state or a gonadotropin -secreting tumor. In true gynecomastia these tests would prove to be unnecessary because the symptoms would regress. Treatment When the primary cause can be identified and corrected, breast enlargement usually diminishes until it usually disappears. For example, "androgen replacement therapy may produce dramatic improvement in men with testicular insufficiency.
However, if the gynecomastia is of long duration (and fibrosis has replaced the original ductal hyperplasia), correction of the primary defect may not be followed by resolution. " (Isselbacher, 2038) In this case, surgery would be the only effective treatment. Candidates for surgery include those with several psychologic and / or cosmetic problems, continued growth, or a suspected malignancy. The treatment selected for this disease is related to how the patient was affected by the disease. The treatment for a person who contracted the disease through certain drug use will be treated different from a person who is affected from a related disease.
If gynecomastia is contracted through drug use, the patient will needs to discontinue the medications that are associated with the disease. The only exception is when there is a life threatening illness involved, and there is no alternative medication available. For those suffering from gynecomastia, the doctor may prescribe anti estrogens such as clomiphene citrate or tamoxifen to eliminate tenderness of the breast. "The non-aromatizable androgen dihydrotesosterone also has been reported to reduce gynecomastia by reducing testicular secretion of estradiol, by decreasing peripheral conversion of precursors to estradiol and by increasing circulating levels of androgen. " (Kohler, 295) In patient with painful gynecomastia and who are not candidates for other therapy, treat-ments with anti estrogens such as tamoxifen may be used. When other related diseases are the cause for the onset of gynecomastia, treatment of these diseases will often cure gynecomastia, too. The removal of a sex steroid produc-ing tumor or treatment of thyroid toxicosis are two examples. Testosterone treatment of androgen deficiency will also cause great improvement in this condition. "Prophylactic radiation of the breasts prior to the institution of diethyl stilbestrol therapy is effective in preventing gynecomastia and has a low complication rate in elderly men. " (Isselbacher, 2039) In most cases of true gynecomastia the signs and symptoms should regress in about a year.
However, in the case of severe gynecomastia where the breast has an increase of fibrous tissue stroma the patient will require a surgical reduction mambo-play. Once this has been done the tissue is sent to a lab to be examined. The results should show elongated circular ducts imbedded in cellular fibrous tissue with a rubbery fatty quality. From these laboratory tests it can be determined if there is any cribriform epithelial hyperplasia or a case of carcinoma. Although the relative risk of carcinoma of the breast is increased in men with gynecomastia, it is rare nevertheless. Statistical Data Gynecomastia is found only in males, and the signs can appear any time in a male's lifetime.
It is the leading breast disorder in males and it accounts for 60 % of all disorders of the male breast. About 85 % of male breast masses are due to gynecomastia. Forty percent of the cases affect pubescent boys occurring most often between the ages of 14 to 15. 5. Approximately 40 % of normal men and up to 70 % of hospitalized men have palpable breast tissue.
Active gynecomastia in autopsy data is between 5 and 9 %. "More than 80 % of their hospitalized patients with a body mass index of 25 kg / m 2 or greater had gynecomastia. " (Williams, 373) About 70 % of pubertal males required no treatment. "If the threshold for judging that the breast is enlarged is set at 2. 0 cm in diameter, the incidence is 32 - 36 % in normal aged men 17 - 58 years. " (Williams, 340) A bloody discharge is present in about 60 % of patients, while a milky discharge is present in about 1 % of patients. Recent Research In the Wilford Hall USAF Medical Center a set of experiments were done to see if there is a connection between 3 B-HSD deficiency and gynecomastia. The researchers tested a male who had developed right side gynecomastia at the age of twenty-four. When a series of tests were run, no other underlying conditions were evident. He was found only to have a deficiency of 3 B-HSD. The patient also had abnormally high ratios of estradiol, estrogen and aldosterone and other serums.
This showed the presence of adrenal sex steroid production on the right side of his body. This is not to say that all males patients with a deficiency of 3 B-HSD will develop gynecomastia. Other patients with the same deficiency showed no signs, and still others with normal 3 B-HSD levels have also been found to have reduced breast tissue. Researchers, however, do believe that the deficiency of 3 B-HSD later in life is quite possibly a frequently unrecognized cause of new-onset gynecomastia.
There are so many causes and factors that lead to the disease gynecomastia that it is very difficult for researchers to try to agree upon one main factor. So many of the cases differ from one another, and, perhaps, no one cause will ever be agreed upon as the leading factor of the disease. As long as there is no other underlying disease or disorder, gynecomastia is not a life threatening disease. Experimentation with hormone therapy is the main research being tested at this time.
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