Abnormal enlargement of breast with palpable breast tissue in men is called gynaecomastia.It is very important to differentiate lipomastia in which there is deposition of adipose tissue in the breast from true gynaecomastia.For differentiating both of them mammography or breast ultrasound can be done.
If there is indeed a presence of true gynaecomastia it indicates an underlying health problem.In most cases some underlying endocrine issue needs evaluation.But here one thing is to be kept in mind that there are three physiological conditions like newborns,adolescence and aging in which gynaecomastai can be seen.
Most of the time the cause of gynaecomastia or growth of breast in men is due to the estrogen and disturbance in the ratio of androgen and the estrogen.The ratio of testosterone and estrogen in plasma is about 300:1.Now gynaecomastia may be visible when this ratio gets disturbed either due to decreased production of testosterone or enhanced production of estrogen or both process may also occur simultaneously.
Sometimes drugs can also cause gynaecomastia because they sometimes act like estrogens or increase the levels of estrogens in the body.Most commonly found agents are ketoconazole,spironolactone,cimetidine,diazepam,omeprazole,marijuana,heroin,ACE inhibitors.
Some pathological conditions in which the raised estrogen can be seen are the testicular tumors,carcinoma of lung.Decreased production of testosterone is seen in anorchia(absent testes),viral orchitis, trauma,castration,renal failure and some syndromes like the Klinefilters syndrome.
Diagnostic evaluation includes proper testicular exam,hormonal assay including plasma estradiol,HCG,testosterone,LH.
When the primary cause can be identified breast enlargement can be promptly corrected and it disappears.But if gynaecomastia is long standing then it is likely that breast tissue enlargement will not disappear.In those cases surgery is the only option.Rare instances of males with gynaecomastia turn into male breast cancers.
Gynaecomastia is really a matter of concern only if the drug history is negative,breast is tender and the breast mass is larger than 4cm in diameter.
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