Endocrine Abstracts

Background: Virginal breast hypertrophy is a rare benign disease. It is a condition of abnormal enlargement of the breast tissue and is characterized by rapid and excessive growth of one or two breasts during peripubertal period. This condition causes significal psychological and physical discomfort to affected adolescents, such as feeling embarrassed, inability to find appropriate clothes, suffering from back and shoulders pain, perhaps the appearance of kyphosis under the weight of the breasts.

Case report: 12 year old girl presented to the Endocrinology Department of our University clinic with the complaint of intensive breast growth for the past 5-6 months. Menarche at age 11 years old, regular menstrual cycles. Hormone levels, such as Prolactin, LH, FSH, estradiol, were within the normal range. Ultrasound of the mammary glands was only significant for dilated ducts up to 2.0 cm and small pelvis without any abnormal features. Within one month of observation, foci of necrosis appeared on the skin mammary glands, with progressive involvement of previously unaffected areas, causing significant pain and suffering. Despite normal hormonal evaluation, a progestin therapy with dydrogesterone at a daily dose of 20 mg/day was initiated. Despite the therapy, the growth of the mammary glands and necrosis continued, therefore the decision was made to proceed with a mastectomy with further mammoplasty at age 18.

Conclusions and follow up: When considering mastectomy in a teenager, an accurate diagnosis and rigorous treatment plan require a team approach, including pediatric, medical and surgical disciplines. Outcomes data are scarce as most available data are limited to small case series or case reports.