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__NOTOC__
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{{Gynecomastia}}
{{Gynecomastia}}
{{CMG}}


{{CMG}}; {{AE}} {{HS}}
==Overview==
==Overview==
==Causes==
Common known causes of [[gynecomastia]] include [[physiological]] hormonal changes, use of [[medications]] and [[Pathological|pathologica]]<nowiki/>l entities such as [[cirrhosis]], [[hyperthyroidism]], [[Testicular tumor|testicular tumors]] and [[hypogonadism]]. Less common causes include [[androgen insensitivity syndrome]], [[Kallmann syndrome]], defects of [[testosterone]] pathway and tumors.
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>


== Causes ==
===Life-threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no known life-threatening causes of [[Gynecomastia|gynecomastia.]]
===Common Causes===
*Drugs:<ref name="pmid22862307">{{cite journal |vauthors=Deepinder F, Braunstein GD |title=Drug-induced gynecomastia: an evidence-based review |journal=Expert Opin Drug Saf |volume=11 |issue=5 |pages=779–95 |year=2012 |pmid=22862307 |doi=10.1517/14740338.2012.712109 |url=}}</ref><ref name="pmid17881754">{{cite journal| author=Braunstein GD| title=Clinical practice. Gynecomastia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 12 | pages= 1229-37 | pmid=17881754 | doi=10.1056/NEJMcp070677 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17881754  }} </ref><ref name="pmid26404748">{{cite journal| author=Lainscak M, Pelliccia F, Rosano G, Vitale C, Schiariti M, Greco C et al.| title=Safety profile of mineralocorticoid receptor antagonists: Spironolactone and eplerenone. | journal=Int J Cardiol | year= 2015 | volume= 200 | issue=  | pages= 25-9 | pmid=26404748 | doi=10.1016/j.ijcard.2015.05.127 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26404748  }} </ref><ref name="pmid17267908">{{cite journal| author=Henley DV, Lipson N, Korach KS, Bloch CA| title=Prepubertal gynecomastia linked to lavender and tea tree oils. | journal=N Engl J Med | year= 2007 | volume= 356 | issue= 5 | pages= 479-85 | pmid=17267908 | doi=10.1056/NEJMoa064725 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17267908  }}</ref>
**[[Antiandrogens]]
**[[5-alpha-reductase inhibitor|5-Alpha reductase inhibtors]]
**[[Cimetidine|Cimetidine]]
**[[Estrogen]]
**[[Gonadotropin-releasing hormone agonist|Gonadotrophin releasing hormone (GnRH) agonist]]
**[[Human chorionic gonadotropin|Human chorionic gonadotropin (hCG)]]
**[[human growth hormone|Recombinant human growth hormone]]
**[[Gynecomastia causes#Causes in Alphabetical Order|Other drugs]]
*[[Idiopathic]]<ref name="pmid17881754">{{cite journal| author=Braunstein GD| title=Clinical practice. Gynecomastia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 12 | pages= 1229-37 | pmid=17881754 | doi=10.1056/NEJMcp070677 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17881754  }}</ref><ref name="pmid28613563">{{cite journal |vauthors=Vandeven H, Pensler J |title= |journal= |volume= |issue= |pages= |year= |pmid=28613563 |doi= |url=}}</ref>
*[[Physiologic]]:<ref name="pmid17881754">{{cite journal |vauthors=Braunstein GD |title=Clinical practice. Gynecomastia |journal=N. Engl. J. Med. |volume=357 |issue=12 |pages=1229–37 |year=2007 |pmid=17881754 |doi=10.1056/NEJMcp070677 |url=}}</ref><ref name="pmid25905330">{{cite journal |vauthors=De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Swerdloff RS, Ng JCM |title= |journal= |volume= |issue= |pages= |year= |pmid=25905330 |doi= |url=}}</ref>
**[[Adolescence]]
**[[Aging]]
**I[[Infancy|nfancy]]
*[[Pathological|Pathologic:]]<ref name="pmid24389786">{{cite journal| author=Ladizinski B, Lee KC, Nutan FN, Higgins HW, Federman DG| title=Gynecomastia: etiologies, clinical presentations, diagnosis, and management. | journal=South Med J | year= 2014 | volume= 107 | issue= 1 | pages= 44-9 | pmid=24389786 | doi=10.1097/SMJ.0000000000000033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24389786  }} </ref><ref name="pmid25905330">{{cite journal |vauthors=De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Swerdloff RS, Ng JCM |title= |journal= |volume= |issue= |pages= |year= |pmid=25905330 |doi= |url=}}</ref><ref name="pmid18728126">{{cite journal| author=Wagner MS, Wajner SM, Maia AL| title=The role of thyroid hormone in testicular development and function. | journal=J Endocrinol | year= 2008 | volume= 199 | issue= 3 | pages= 351-65 | pmid=18728126 | doi=10.1677/JOE-08-0218 | pmc=2799043 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18728126  }} </ref><ref name="pmid2310274">{{cite journal |vauthors=Cavanaugh J, Niewoehner CB, Nuttall FQ |title=Gynecomastia and cirrhosis of the liver |journal=Arch. Intern. Med. |volume=150 |issue=3 |pages=563–5 |year=1990 |pmid=2310274 |doi= |url=}}</ref>
**[[Cirrhosis]]
**[[Chronic kidney disease|Chronic Renal disease]]
**[[Hyperthyroidism]]
**[[Hypogonadism|Primary hypogonadism]]
**[[Gynecomastia|Persistent pubertal gynecomastia]]
**[[Hypogonadism|Secondary hypogonadism]]
**[[Testicular tumor|Testicular tumors]]
===Less Common Causes<ref name="pmid12736278">{{cite journal| author=Shozu M, Sebastian S, Takayama K, Hsu WT, Schultz RA, Neely K et al.| title=Estrogen excess associated with novel gain-of-function mutations affecting the aromatase gene. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 19 | pages= 1855-65 | pmid=12736278 | doi=10.1056/NEJMoa021559 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12736278  }} </ref>===
*[[Aromatase|Aromatase overexpression]]
*[[Androgen insensitivity syndrome|Androgen insensitivity syndrome]]
*[[Gynecomastia causes#Causes in Alphabetical Order|Drugs]]
*[[Kallmann syndrome]]
*[[Testosterone|Testosterone pathway defects]]
*[[Tumors]]
**[[Gastric carcinoma]]
**[[Hepatic tumor|Hepatic Tumor]]
**[[Large cell carcinoma of the lung|Large cell carcinoma of lung]]
**[[Pituitary tumor|Pituitary Tumor]]
**[[Renal cell carcinoma]]
'''To review a complete list of gynecomastia causes, [[Gynecomastia causes#Causes in Alphabetical Order|click here.]]'''
===Genetic Causes===
*[[Familial|Familial prepubertal gynecomastia]]<ref name="pmid12736278">{{cite journal |vauthors=Shozu M, Sebastian S, Takayama K, Hsu WT, Schultz RA, Neely K, Bryant M, Bulun SE |title=Estrogen excess associated with novel gain-of-function mutations affecting the aromatase gene |journal=N. Engl. J. Med. |volume=348 |issue=19 |pages=1855–65 |year=2003 |pmid=12736278 |doi=10.1056/NEJMoa021559 |url=}}</ref>
==Causes in Alphabetical Order==
Causes of [[gynecomastia]] in alphabetical order:<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
{{columns-list|
* [[Acromegaly]]
* [[Acromegaly]]
* [[Adrenal Cancer]]
* [[Adrenal Cancer]]
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* Local irradiation
* Local irradiation
* [[Lung cancer]]
* [[Lung cancer]]
* Medications/drugs:
* '''Medications/drugs''':
*:* [[Alcohol]]
*:* [[Alcohol]]
*:* [[Anabolic]]
*:* [[Anabolic]]
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*:* [[Efavirenz]]
*:* [[Efavirenz]]
*:* [[Estrogen]]s
*:* [[Estrogen]]s
*:* [[Etravirine]]
*:* [[Etomidate]]
*:* [[Etomidate]]
*:* [[Febuxostat]]
*:* [[Febuxostat]]
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*:* [[Haloperidol]]
*:* [[Haloperidol]]
*:* [[Heroin]]
*:* [[Heroin]]
*:* [[Histrelin]]
*:* [[Human chorionic gonadotropin]] ([[HCG]])
*:* [[Human chorionic gonadotropin]] ([[HCG]])
*:* [[Iloperidone]]
*:* [[Iloperidone]]
Line 81: Line 131:
*:* [[Tricyclic antidepressants]]
*:* [[Tricyclic antidepressants]]
*:* [[Trifluoperazine]]
*:* [[Trifluoperazine]]
*:* [[Topical tree oil]]
*:* [[Topical lavender oil]]
*:* [[Verapamil]]
*:* [[Verapamil]]
*:* [[Melatonin]]
*:* [[Melatonin]]
* Persistent postpubertal/elderly gynecomastia
*:* Persistent postpubertal/elderly gynecomastia
* Physiologic gynecomastia of puberty
*:* Physiologic gynecomastia of puberty
* Re-feeding after starvation
*:* Re-feeding after starvation
* [[Stomach cancer]]
*:* [[Stomach cancer]]
* [[Testicular cancer]]
*:* [[Testicular cancer]]
* Testicular trauma
*:* Testicular trauma
* [[Thyroid Disease]]
*:* [[Thyroid Disease]]
* [[Torsion of testes]]
*:* [[Torsion of testes]]
* Viral [[orchitis]]
*:* Viral [[orchitis]]}}
 
According to underlying pathophysiology, the causes of gynecomastia are:
=== Decreased Testosterone ===
* [[Androgen-insensitivity syndrome]]
* [[Congenital anorchia]]
* [[Five alpha-reductase deficiency]]
* [[Hypopituitarism]]
* [[Kallman Syndrome]]
* [[Klinefelter Syndrome]]
* [[Renal Failure]]
* Testicular trauma
* Torsion of the testes
* Viral [[orchitis]]
 
=== Increased Estrogens ===
* [[Adrenal cancer]]
* Chronic liver disease
* [[Extragonadal germ cell tumors]]
* Familial gynecomastia
* [[Hyperthyroidism]]
* [[Kidney carcinoma]]
* [[Liver cancer]]
* [[Lung carcinoma]]
* Malnutrition
* Other gastrointestinal (GI) tract carcinoma
* [[Stomach cancer]]
* [[Testicular cancer]]
 
===Physiologic causes===
* Benign gynecomastia of adolescence
* Drugs
* Familial gynecomastia
* Gynecomastia in the newborn
* Gynecomastia of aging
 


===References===
==References==
{{reflist|2}}
{{reflist|2}}
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{{WH}}

Latest revision as of 21:09, 10 January 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

Common known causes of gynecomastia include physiological hormonal changes, use of medications and pathological entities such as cirrhosis, hyperthyroidism, testicular tumors and hypogonadism. Less common causes include androgen insensitivity syndrome, Kallmann syndrome, defects of testosterone pathway and tumors.

Causes

Life-threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no known life-threatening causes of gynecomastia.

Common Causes

Less Common Causes[10]

To review a complete list of gynecomastia causes, click here.

Genetic Causes

Causes in Alphabetical Order

Causes of gynecomastia in alphabetical order:[11][12]

References

  1. ↑ Deepinder F, Braunstein GD (2012). "Drug-induced gynecomastia: an evidence-based review". Expert Opin Drug Saf. 11 (5): 779–95. doi:10.1517/14740338.2012.712109. PMID 22862307.
  2. ↑ 2.0 2.1 2.2 Braunstein GD (2007). "Clinical practice. Gynecomastia". N Engl J Med. 357 (12): 1229–37. doi:10.1056/NEJMcp070677. PMID 17881754.
  3. ↑ Lainscak M, Pelliccia F, Rosano G, Vitale C, Schiariti M, Greco C; et al. (2015). "Safety profile of mineralocorticoid receptor antagonists: Spironolactone and eplerenone". Int J Cardiol. 200: 25–9. doi:10.1016/j.ijcard.2015.05.127. PMID 26404748.
  4. ↑ Henley DV, Lipson N, Korach KS, Bloch CA (2007). "Prepubertal gynecomastia linked to lavender and tea tree oils". N Engl J Med. 356 (5): 479–85. doi:10.1056/NEJMoa064725. PMID 17267908.
  5. ↑ Vandeven H, Pensler J. PMID 28613563. Missing or empty |title= (help)
  6. ↑ 6.0 6.1 De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Swerdloff RS, Ng J. PMID 25905330. Vancouver style error: initials (help); Missing or empty |title= (help)
  7. ↑ Ladizinski B, Lee KC, Nutan FN, Higgins HW, Federman DG (2014). "Gynecomastia: etiologies, clinical presentations, diagnosis, and management". South Med J. 107 (1): 44–9. doi:10.1097/SMJ.0000000000000033. PMID 24389786.
  8. ↑ Wagner MS, Wajner SM, Maia AL (2008). "The role of thyroid hormone in testicular development and function". J Endocrinol. 199 (3): 351–65. doi:10.1677/JOE-08-0218. PMC 2799043. PMID 18728126.
  9. ↑ Cavanaugh J, Niewoehner CB, Nuttall FQ (1990). "Gynecomastia and cirrhosis of the liver". Arch. Intern. Med. 150 (3): 563–5. PMID 2310274.
  10. ↑ 10.0 10.1 Shozu M, Sebastian S, Takayama K, Hsu WT, Schultz RA, Neely K; et al. (2003). "Estrogen excess associated with novel gain-of-function mutations affecting the aromatase gene". N Engl J Med. 348 (19): 1855–65. doi:10.1056/NEJMoa021559. PMID 12736278.
  11. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  12. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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