Endocrine Abstracts

Introduction: Gynecomastia is an enlargement of male breast glandular tissue caused by an imbalance of the hormones androgens and estrogens. It can be physiological at different stages of life (birth, adolescence, senescence), caused by medication or reveal a serious pathology. The aim of our study was to evaluate the characteristics of presentation, biochemical profile, and etiology of gynecomastia.

Methods: A retrospective study was conducted at the endocrinology department of the Rabta Hospital in Tunis including 100 patients who presented with gynecomastia between January 2015 and December 2020. Clinical and paraclinical data were collected from medical records.

Results: The mean age of our patients was 37.16 years with extremes ranging from 11 years to 88 years. Seven patients (7%) had a history of cryptorchidism and testicular ectopy. Impuberism and late puberty were noted in 17 patients (17%). The mean duration of Gynecomastia before seeking specialized endocrine care was 78 months with an acute onset in 19% of cases. On physical examination, 56 patients (56%) had bilateral and symmetrical gynecomastia, 19 patients (19%) had bilateral and asymmetrical and 25% unilateral gynecomastia. 15 patients had stage I, 33 patients had stage II and 52 patients had stage III gynecomastia. Testosteronemia was measured in 43 patients and was low in 26 patients (26%). Gynecomastia was considered physiological in 25 patients (25%). The etiology of gynecomastia was considered to be drug-induced in 15 patients (15%), including spironolactone in six patients. The other drugs involved were chemotherapy and dopaminergic antagonists. Other causes were non-functioning pituitary adenomas, prolactinomas, isolated hypogonadotropic hypogonadism, testicular diseases, hypothyroidism and hyperthyroidism in 7%, 6%, 8%, 7%, 2% and 1% of the cases respectively. Idiopathic gynecomastia was found in 29% of cases.

Conclusion: Gynecomastia is a frequent and often benign pathology but it can be the expression of a relevant underlying endocrine disease or even tumor pathology. This highlights the importance of an adequate and complete clinical, biochemical, and imaging assessment of every patient presenting with gynecomastia.