Sex Hormone Profile in Pubertal Boys With Gynecomastia and Pseudogynecomastia

Abstract

Content Gynecomastia (defined by proliferation of glandular elements) and pseudogynecomastia (defined by adipose tissue) are frequent in pubertal boys. An association with sex hormones and the growth hormone axis has been discussed. Objective The objective of this work is to compare sex hormones, insulin-like growth factor 1 (IGF-1), and insulin-like growth factor binding protein 3 (IGFBP-3) between boys with gynecomastia and pseudogynecomastia (separation by ultrasound). Design An observational study was performed. Setting The setting of this study was an outpatient clinic. Participants A total of 124 pubertal boys (mean age 14 ± 2 years) with breast enlargement and 84 healthy boys (mean age 14 ± 2 years) without breast enlargement participated in this study. Interventions No interventions were performed. Main outcome measures Measurements were taken for sex hormones (progesterone, estradiol [E2], estriol, estrone, androstendione, testosterone [T], dihydrotestosterone) measured by liquid chromatography–tandem mass spectrometry, as well as gonadotropins, prolactin, IGF-1, and IGFBP-3. Results Eighty-six boys suffered from gynecomastia and 38 from pseudogynecomastia. In boys with gynecomastia, the E2/T ratio (median 22, interquartile range [IQR] 8-75) was significantly (P < .05) higher compared to boys with pseudogynecomastia (median 12, IQR 5-21) or healthy controls without breast enlargement (median 18, IQR 6-44) even after adjustment for testes volume. T concentrations were significantly (P < .05) lower in boys with gynecomastia (median 1.8, IQR 0.7-4.2 nM/L) compared to boys with pseudogynecomastia (median 4.3, IQR 1.4-6.9 nM/L) or healthy controls without breast enlargement (median 3.1, IQR 0.6-7.6 nM/L). Boys with gynecomastia did not differ from boys with pseudogynecomastia according to other sex hormones, prolactin, IGF-1, or IGFBP-3 concentrations. Conclusions True gynecomastia is characterized by a relative T deficiency to E2 concentrations in contrast to pseudogynecomastia.

Transition from gynaecomastia to lipomastia in pubertal boys

“…All pubertal boys presenting with gynaecomastia at the Vestische Kinder‐ und Jugendklinik Datteln, University of Witten Herdecke in the time period between 1.10.2013 and 2.5.2019 and recruited for our previous study 3 were contacted for this follow‐up examination. This cohort consisted of 86 boys with gynaecomastia.…”

“…Boys with pseudogynaecomastia (including lipomastia) at baseline or gynaecomastia due to syndromes (eg Klinefelter syndromes) or disorders of sexual development or taking any medication were also excluded from the study. For details of the initial study recruitment see 3 …”

“…The two forms can be differentiated by palpation but more accurately by ultrasound 2 . We have previously demonstrated that an imbalance between testosterone and oestradiol concentrations is the most striking finding in pubertal boys with gynaecomastia compared to pubertal boys with lipomastia 3 …”

“…The aim of this longitudinal study was to identify predictors of breast diameter regression in pubertal boys with gynaecomastia based on the diagnostic work‐up at first presentation in our clinic consisting of ultrasound of breast, gonadotropins, IGF‐1, IGFBP‐3, and a comprehensive serum profile of sex steroid hormones and their precursors, 3 using a liquid chromatography‐tandem mass spectrometry (LC‐MS/MS) steroid profiling method 12 …”

What Accounts for the Increased Incidence of Gynecomastia Diagnosis in Denmark from 1998–2017?

“…This definition differentiates it from breast enlargement due to the deposition of fat (pseudogynecomastia, lipomastia), neoplasms, or inflammation. All males have some breast glandular tissue; gynecomastia often represents an imbalance between the stimulatory effects of estrogen and the inhibitory effects of androgens on the glandular component, while pseudogynecomastia is commonly found in boys and men who are overweight ( 1 , 2 ). Nevertheless, some authors and physicians lump all causes of breast enlargement in males together under the term “gynecomastia” ( 3 ).…”