WHAT'S KNOWN ON THIS SUBJECT:Being an androgen antagonist and a possible estrogen agonist, several endocrinologic effects of DEHP have been demonstrated mostly in vitro and in animals. A limited number of studies have linked the endocrinologic effects of DEHP and its metabolite, MEHP, in humans.
WHAT THIS STUDY ADDS:To our knowledge, this is the first study to define a possible effect of DEHP and MEHP in pubertal gynecomastia. The etiology of pubertal gynecomastia is attributed either to excessive estrogen, deficient androgen, increased aromatase enzyme activity, or a combination. abstract OBJECTIVE: Several untoward health effects of phthalates, which are a group of industrial chemicals with many commercial uses including personal-care products and plastic materials, have been defined. The most commonly used, di-(2-ethylhexyl)-phthalate (DEHP), is known to have antiandrogenic or estrogenic effects or both. Mono-(2-ethylhexyl)-phthalate (MEHP) is the main metabolite of DEHP. In this study, we aimed to determine the plasma DEHP and MEHP levels in pubertal gynecomastia cases.
PATIENTS AND METHODS:The study group comprised 40 newly diagnosed pubertal gynecomastia cases who were admitted to Hacettepe University Ihsan Dog ramacı Children's Hospital. The control group comprised 21 age-matched children without gynecomastia or other endocrinologic disorder. Plasma DEHP and MEHP levels were measured by using high-performance liquid chromatography. Serum hormone levels were determined in some pubertal gynecomastia cases according to the physician's evaluation.
RESULTS:Plasma DEHP and MEHP levels were found to be statistically significantly higher in the pubertal gynecomastia group compared with the control group (P Ͻ .001) (DEHP, 4.66 Ϯ 1.58 and 3.09 Ϯ 0.90 g/mL, respectively [odds ratio: 2.77 (95% confidence interval: 1.48 -5.21)]; MEHP, 3.19 Ϯ 1.41 and 1.37 Ϯ 0.36 g/mL [odds ratio: 24.76 (95% confidence interval: 3.5-172.6)]). There was a statistically significant correlation between plasma DEHP and MEHP levels (r: 0.58; P Ͻ .001). In the pubertal gynecomastia group, no correlation could be determined between plasma DEHP and MEHP levels and any of the hormone levels.CONCLUSIONS: DEHP, which has antiandrogenic or estrogenic effects, may be an etiologic factor in pubertal gynecomastia. These results may pioneer larger-scale studies on the etiologic role of DEHP in pubertal gynecomastia. Pediatrics 2010;125:e122-e129