Objectives To evaluate the characteristics of presentation, biochemical profile, and etiology of gynecomastia in adults. Methods Medical records of 237 men aged 18-85 years with gynecomastia were evaluated. Results Highest prevalence of gynecomastia was observed between 21 and 30 years (n = 74; 31.2%). The most common presenting complaints were aesthetic concerns (62.8%) and breast pain (51.2%). 25.3% of the subjects had a history of pubertal gynecomastia. 56.5% had bilateral gynecomastia. 39.9% were overweight and 22.8% were obese. The etiology could not be identified in 45.1% of the cases; the most frequent identified causes were anabolic steroids consumption (13.9%), hypogonadism (11.1%), and use of pharmaceutical drugs (7.8%). Patients with bilateral gynecomastia had a longer history of disease, higher BMI, and lower testosterone levels. Conclusions Patients with gynecomastia presented more often with aesthetic concerns and secondarily with breast pain. The most frequent final diagnosis was idiopathic gynecomastia, whereas the most frequent identified etiologies were anabolic steroids consumption, hypogonadism, and use of pharmaceutical drugs. Despite the low frequency of etiologies such as thyroid dysfunction or adrenal carcinoma, we emphasize the importance of a thorough assessment of the patient, as gynecomastia may be the tip of the iceberg for the diagnosis of treatable diseases.

SUMMARYMen with type 2 diabetes mellitus (DM2) have lower testosterone levels and a higher prevalence of hypogonadism. It still remains unclear the mechanism by which there is a relationship between hypogonadism and DM2. The objective was to evaluate the hypothalamic-pituitary-gonadal axis at different levels in eugonadal patients with DM2. Fourteen patients with DM2 (DM2 group) and 15 subjects without DM2 (normal glucose tolerance test) as control group (CG) were included. We assessed: (i) fasting glucose, insulin, Homeostasis Model Assessment (HOMA); (ii) luteinizing hormone (LH) pulsatility through blood collections every 10 min for 4 h; (iii) gonadotropin-releasing hormone (GnRH) test: basal LH and 30, 60 and 90 min after 100 lg of i.v. GnRH; (iv) human chorionic gonadotropin (hCG) test: basal total testosterone (TT), bioavailable testosterone (BT), free testosterone (FT), estradiol (E2), bioavailable E2 (BE2) and sex hormone-binding globulin (SHBG) and 72 h post 5000 IU of i.m. hCG. There were no differences in age, body mass index and waist circumference between groups. Glucose was higher in the DM2 group vs. CG: 131.1 AE 25.5 vs. 99.1 AE 13.6 mg/ dL, p = 0.0005. There were no difference in basal insulin, HOMA, TT, BT, FT, E2, BE2, SHBG and LH levels between groups. The DM2 group had lower LH pulse frequency vs. CG: 0.8 AE 0.8 vs. 1.5 AE 0.5 pulses, p = 0.009. Differences in LH pulse amplitude were not found. A negative correlation was found between the number of LH pulses and glucose, r: À0.39, p = 0.03. There were no differences in the response of LH to GnRH between groups nor in the response of sexual steroids and SHBG to hCG. Patients with DM2 showed lower hypothalamic pulse frequency without changes in the pituitary response to GnRH nor testicular response to hCG. Glucose levels negatively correlated with the number of LH pulses which suggests a negative effect of hyperglycaemia in the hypothalamic secretion of GnRH.

Purpose Vitamin D (VD) acts on sperm motility, capacitation and survival but its role in steroidogenesis is less clear. Aims: To analyze seasonal variations in sex steroids and VD in a healthy male population. Materials and Methods Twenty-nine healthy males, 34.0±4.8 years were included. Blood collection in winter (W) and summer (S) was performed to measure: 25OHD, total testosterone (TT), free testosterone (FT), estradiol (E2), luteinizing hormone (LH), and sex hormone binding globulin (SHBG). Testosterone/estradiol (T/E2) ratio was calculated. Results In W, lower levels of 25OHD: 18.8±7.2 ng/mL vs . 38.8±11.9 ng/mL (p<0.0001) and LH: 3.5±1.2 mU/mL vs . 3.9±1.5 mU/mL (p=0.05), and higher levels of TT: 501.9±157.7 ng/dL vs . 405.0±128.0 ng/dL (p=0.0003), FT: 11.8±4.1 ng/dL vs . 10.2±3.7 ng/dL (p=0.017), SHBG: 28.5±10.9 nmol/L vs . 23.6±7.9 nmol/L (p=0.002) and T/E2 ratio: 30.7±19.7 ng/dL/pg/mL vs . 17.3±3.6 ng/dL/pg/mL (p=0.0015) with no variation in E2 levels were observed. A positive correlation between 25OHD and E2 (r=0.28, p=0.04) and negative correlations between 25OHD and TT (r=−0.27, p=0.049), 25OHD and FT (r=−0.32, p=0.01), and 25OHD and T/E2 (r=−0.44, p=0.0008) were found. Conclusions In healthy young male population, seasonal variations were observed in 25OHD and LH levels (higher in S) and in TT, FT, SHBG levels, and T/E2 (higher in W). Lower values of TT and FT in S are accompanied by higher levels of LH, which rules out a central mechanism for lowering testosterone. 25OHD negatively correlated with TT, FT, and T/E2 and positively correlated with E2, suggesting a relationship between VD status and changes in gonadal steroids.

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