Endocrine Abstracts

Introduction: Gynecomastia is defined as the benign proliferation of the mammary glands in males, which results from an excess of estrogens, androgen deficiency, hormone resistance, or altered ratio of estrogens to androgens. It can be unilateral or bilateral. The aim of our study was to describe the therapeutic aspects and the evolution of gynecomastia.

Methods: This is a retrospective descriptive study of 100 patients who presented with gynecomastia at the endocrinology department of the Rabta hospital between January 2015 and December 2020. Clinical and paraclinical data were collected from medical records.

Results: Our population had a mean age of 37.16 ± 21.7 years at the time of the first visit. The mean age of puberty was 13.9 ± 2.7 years. Seven patients (7%) had a past medical history of testicular ectopy and cryptorchidism. Physical examination showed the presence of glandular tissue in all patients and diagnosis was documented by ultrasound and/or mammography in 60 patients. Biological workup revealed hypogonadotropic hypogonadism in 15 patients, including 7 patients with non-functional pituitary adenoma and 8 patients with isolated hypogonadotropic hypogonadism, hyperprolactinemia with prolactinoma in 6 patients, hypothyroidism in 2 patients, and hyperthyroidism in 1 patient. Gynecomastia was secondary to testicular disease in 7 patients. In addition, 15 patients had drug-induced gynecomastia. Finally, gynecomastia was physiological in 25 patients and idiopathic in 29 others. Regarding the management of gynecomastia, 29 patients received treatment for the etiology, 11 patients received testosterone enanthate injections. Nine patients received local treatment with androstanolone and 12 patients underwent cosmetic surgery. The rest of the patients were monitored and did not receive any treatment. The evolution was marked by clinical improvement in 38% of cases.

Conclusion: Each case of gynecomastia should be subjected to a precise etiological workup including at least a testosterone and estradiol dosage. The treatment modalities of gynecomastia depend on the results of the etiological investigation.