Endocrine Abstracts

Introduction: Gynecomastia, marked by mammary gland hypertrophy, arises from an imbalance between androgens and estrogens. Notable etiologies include hypogonadism, tumors, iatrogenic causes, and idiopathic factors.

A case report: A patient aged 8 years and 10 months, with no pathological history, was admitted for further management of right unilateral gynecomastia. The functional signs included unilateral right hypertrophy in the retroareolar region. On physical examination, firm unilateral palpation of 3 cm on the right, eccentric, with no signs of hyperthyroidism or hypercorticism, and the right and left testicular size measuring 4 ml. The diagnosis of idiopathic gynecomastia was confirmed by examination results, revealing a nodular tumefaction, well-limited, regular in contour, hypoechoic, finely heterogeneous, measuring 3×3×0.6 cm. Testicular ultrasound showed no abnormalities. Additional tests, including TSH:1.6 uui/ml, renal and hepatic tests without abnormalities, FSH:1 mui/l, LH:0.12 mui/l, Testosterone:0.10 mg/l, BHCG:0.11 mui/l, and estradiol:2 pg/ml, were within normal ranges. Due to aesthetic discomfort, the patient was referred to the plastic surgery department for further care.

Discussion: In contrast to gynecomastia in adolescents and adult men, prepubertal gynecomastia is a rare occurrence. The primary objective of the interview and clinical examination is to identify warning signs of non-physiological gynecomastia. Various drugs, whether toxic or topical, are linked to gynecomastia and warrant investigation before any additional work-up. The key etiological emergencies to rule out involve tumoral origins, including germinal testicular and adrenal causes. To biology of renal, hepatic, and thyroid function, alongside a hormonal workup (LH, FSH, estradiol, total and free testosterone, SHBG, β-HCG), is necessary. Management relies, on one hand, on reconstructive surgery in cases of significant discomfort. Aromatase inhibitors can also contribute to preventing recurrence.

Conclusion: Gynecomastia represents an infrequent clinical scenario that may signify an underlying disease. A thorough clinical evaluation, paired with an initial work-up, guides the etiological diagnosis. A specific cause is seldom identified, and in 90% of cases, prepubertal gynecomastia is classified as idiopathic

References: 1. Braunstein GD. Gynecomastia. N Engl J Med. 2007;357(12):1229-37.

2. Neslihan Cuhaci, Sefika Burcak Polat, Berna Evranos, Reyhan Ersoy, and Bekir Cakir. Gynecomastia. Indian J Endocrinol Metab. 2014 Mar-Apr; 18(2): 150–158.

3. Ma NS, Geffner ME. Gynecomastia in prepubertal and pubertal men. DOI: 10.1097/MOP.0b013e328305e415. PMID: 18622206