Endocrine Abstracts

Introduction

Gynecomastia is characterized by the abnormal enlargement of one or both male breasts due to proliferation of the glandular tissue, with many possible underlying causes. A documented rare cause of gynecomastia is chest trauma.

Case report

We present a case of a 53-year-old male patient, with a personal history of arterial hypertension and depressive disorder, medicated with fluoxetine, perindopril, amlodipine and indapamide. The patient had a documented history of a three-story fall six months before, with associated chest trauma and rib fracture, which required admission in an intensive care unit. The patient was referred to an endocrinology consult following a slightly painful, progressive increase in volume of the right breast, with no associated nodules or masses, which started after the fall. The blood analysis were in the normal range, including alpha-fetoprotein < 1.3 ng/ml, FSH 7.1 mUI/l (RV 1.4–18.1), LH 6.3 mUI/l (RV 1.5–9.3), prolactin 7.7 ng/ml (RV 2.1–17.7), beta-HCG < 0.1UI/l, total testosterone 270 ng/dl (RV 193–740). The patient underwent a breast ultrasound scan that confirmed bilateral, asymmetrical gynecomastia, with a right breast gland of 22 mm and left gland with 12 mm. Due to the presence of a hypoechogenic retroareolar area on the right gland the patient underwent an ultrasound-guided micro biopsy. The histological result was benign. After one year of follow-up the patient still presents with gynecomastia, although in slight regression.

Discussion

We report a case of gynecomastia where the only identified trigger was the acute chest trauma. The underlying pathophysiological mechanisms remain unclear, but some authors propose that the local release of growth factors plays a role, leading to the differentiation and proliferation of precursor cells, resulting in mature glandular enlargement.