Causes and Metabolic Consequences of Gynecomastia in Adult Patients

Abstract

Background Gynecomastia (GM) is a benign enlargement of male breast due to glandular tissue proliferation. GM is a symptom of systemic or local hormonal disturbances, which could be associated with functional changes or pathological conditions. However, the long-lasting steroid imbalance in men with GM might exert negative influence on their metabolic health. Methods A total of 110 adult men with symptomatic GM were included in the present retrospective cross-sectional study. Anthropometric, metabolic, and hormonal data of the patients were collected. Results In almost 64% of GM patients, the underlying pathological condition was identified. Moreover, the development of GM was among the primary symptoms leading to the proper diagnosis in more than 40% of hypogonadal patients. The prevalence of metabolic syndrome (MS) was 53%; the highest prevalence of MS was found in patients with medication-induced GM and in the hypogonadal patients, whereas the lowest prevalence was observed in men with idiopathic postpubertal GM despite the similar degree of obesity. The lower testosterone levels were associated with more unfavorable lipid profile in the GM patients. Conclusion The development of GM in adults might be an important symptom of an underlying gonadal disease. Moreover, it could be associated with an increased risk of metabolic disturbances. Our results support the need of detailed laboratory and hormonal investigations in patients with GM including targeted screening for metabolic disturbances. Further longitudinal studies are needed to evaluate the long-term consequences of sex hormones imbalance on cardiovascular morbidity and mortality in adults with GM.

Biochemical features of eugonadal patients with idiopathic gynaecomastia: A retrospective cross‐sectional study

“…Indeed, fasting or postprandial hyperglycaemia were reported in approximately 30% of them (Robeva, 2019). In the present study, we found that 12% of patients had fasting hyperglycaemia, but none had diabetes.…”

“…In the present study, we found that 12% of patients had fasting hyperglycaemia, but none had diabetes. Recently, Robeva reported significantly higher triglycerides levels in hypogonadal men with gynaecomastia compared with eugonadal men with idiopathic gynaecomastia (median, 1.4 vs. 0.9 mmol/L) (Robeva, 2019).). Significant differences in triglycerides levels were also found between pubertal boys with idiopathic gynaecomastia and healthy boys (median 1.3 vs. 1.1 mmol/L), together with a significant reduction in HDL-c levels (1.2 vs. 1.3 mmol/L respectively) (Al Alwan, 2013).…”

“…The authors hypothesised that the higher 2D:4D ratio may be linked to increased prenatal exposure to estrogens and/or decreased exposure to testosterone (Kasielska-Trojan, 2019). It has been demonstrated that substances with oestrogenic properties or oestrogen-treated food can promote breast growth, and therefore, may have a role in some cases of idiopathic gynaecomastia (Robeva, 2019) In this regard, despite our careful history taking focusing on recent exposure to medications and xenoestrogens (Table 1), we cannot exclude unsaid/unknown unintentional exposure to substances having such properties in our patients.…”

“…0.9 mmol/L) (Robeva, 2019).). Significant differences in triglycerides levels were also found between pubertal boys with idiopathic gynaecomastia and healthy boys (median 1.3 vs. 1.1 mmol/L), together with a significant reduction in HDL-c levels (1.2 vs. 1.3 mmol/L respectively) (Al Alwan, 2013).…”

“…In such patients, no systemic imbalance between estrogens and androgens can be demonstrated (Costanzo, 2018;Ersoz, 2002). Furthermore, alterations of glucose and lipid metabolism were reported in a number of studies (Al Alwan, 2013;Ersoz, 2002;Robeva, 2019;Yazici, 2010). All these studies were either cohort studies or case-control studies, the latter including agematched control groups.…”