Prepubescent unilateral gynecomastia secondary to excessive soy consumption.

OBJECTIVE: We present a case of an unusual cause of prepubertal gynecomastia. CASE PRESENTATION: Enlargement of breast tissue in males, or gynecomastia, is a rare condition in prepubescent boys. We describe an 8-year-old male who developed unilateral gynecomastia secondary to marked dietary soy consumption. While the majority of cases are idiopathic, soy products, particularly those consumed by our patient, can contain high levels of phytoestrogens, which have been documented in limited case studies to contribute to abnormal development of breast tissue in adolescent and adult males. To our knowledge, this is the first documented case of gynecomastia occurring in a prepubescent patient resulting from excessive intake of dietary soy. Importantly, we also report a complete resolution of gynecomastia upon exclusion of dietary products containing significant amounts of soy. CONCLUSION: While soybeans and soy-derived products can be an important source of nutrition for some, those with abnormal sensitivity to phytoestrogens may benefit from limiting dietary soy consumption to avoid potential adverse effects, including gynecomastia.

Gynaecomastia: a cosmetic concern or a concerning clinical sign?

Gynaecomastia is common and often physiological, leading to frequent dismissal as a cosmetic condition. It can however be a symptom of underlying hormone imbalance, which requires further assessment to exclude underlying sinister pathology. We discuss a rare cause of gynaecomastia that demonstrates the importance of a holistic approach to patient assessment.

Tratamiento quirúrgico de la ginecomastia puberal con anestesia local infiltrativa / Surgical treatment of pubertal gynecomastia with infiltrative local anesthesia

Introducción: la ginecomastia se define como el crecimiento benigno de la glándula mamaria del hombre, proceso secundario a la proliferación glandular. Las alteraciones estéticas que causa repercuten negativamente en quienes la padecen. Pasados dos años de instaurada, el tratamiento farmacológico no suele ser efectivo y se recomienda el quirúrgico como única opción.Objetivo: presentar el caso de un adolescente diagnosticado de ginecomastia puberal e intervenido quirúrgicamente. No obstante ser esta enfermedad frecuente, pocos pacientes aceptan el tratamiento quirúrgico; de ahí que sea de interés para los especialistas.Presentación del caso: paciente masculino de 16 años de edad, color de la piel blanco, con antecedentes de sobrepeso desde la infancia y ninguna enfermedad asociada a su condición actual. Refirió que aproximadamente desde los 11 o 12 años notó aumento de volumen de las mamilas, asociado a dolor de moderada intensidad a la presión y palpación. Se le realizaron exámenes de laboratorio para descartar un posible trastorno hormonal y un ultrasonido diagnóstico de ambas mamas. Se le recomendó como opción viable la intervención quirúrgica (liposucción simple, combinada con adenectomía bilateral). Este paciente fue el primer caso pediátrico intervenido quirúrgicamente en la institución empleando anestesia local infiltrativa.Conclusiones: cuando no se produce la regresión espontánea al estado normal la única opción de tratamiento es la intervención quirúrgica, la cual pocos pacientes aceptan. En este caso, el joven afectado y su familia dieron su consentimiento para la operación, que dio los resultados esperados desde el punto de vista estético(AU)

Introduction: gynecomastia is defined as the benign growth of the mammary gland of man, a secondary process to glandular proliferation. The aesthetic alterations that it causes have a negative impact on those who suffer from it. After two years, pharmacological treatment is not usually effective and surgery is recommended as the only option.Objective: to present the case of a teenager diagnosed with pubertal gynecomastia and surgically treated. Despite being this frequent disease, few patients accept surgical treatment.Case presentation: male patient of 16 years of age, white, with a history of overweight since childhood and no disease associated with his current condition. He reported that approximately from 11 or 12 years old he noticed an increase in the nipple volume, associated with pain of moderate intensity at the pressure and palpation. He underwent laboratory tests to rule out a possible hormonal disorder and a diagnostic ultrasound of both breasts. Surgery was recommended as a viable option (simple liposuction, combined with bilateral adenectomy). This patient was the first pediatric case surgically treated at the institution using infiltrative local anesthesia.Conclusions: when spontaneous regression to the normal state does not occur, the only treatment option is surgical intervention, which few patients accept. In this case, the affected youth and his family gave their consent for the operation, which gave the expected results from the aesthetic point of view(AU)

Unilateral gynecomastia and hypokalemic periodic paralysis as first manifestations of Graves' disease.

A 39-year-old Chinese man presented to the study hospital with right-sided gynecomastia. Underlying Graves' disease was not diagnosed until recurrent episodes of hypokalemic periodic paralysis were observed. The estradiol (E2) and progesterone levels and the E2-to-testosterone (T) (E2/T) ratio of the patient were elevated before treatment. Immediate intravenous potassium supplementation was started to reverse the paralysis. Additionally, antithyroid drugs were administered to restore a euthyroid state. After treatment, the patient gained strength. Gynecomastia regressed with a return to the euthyroid state; the E2 and progesterone levels normalized and the plasma E2/T ratio declined. In addition to the classic symptoms, some atypical symptoms of Graves' disease may also occur. One of the challenges lies in recognizing the underlying etiology. Early diagnosis and appropriate treatment can avoid unnecessary investigations and serious cardiopulmonary complications.

Soybean isoflavone exposure does not have feminizing effects on men: a critical examination of the clinical evidence.

OBJECTIVE: To critically evaluate the clinical evidence, and when not available, the animal data, most relevant to concerns that isoflavone exposure in the form of supplements or soy foods has feminizing effects on men. DESIGN: Medline literature review and cross-reference of published data. RESULT(S): In contrast to the results of some rodent studies, findings from a recently published metaanalysis and subsequently published studies show that neither isoflavone supplements nor isoflavone-rich soy affect total or free testosterone (T) levels. Similarly, there is essentially no evidence from the nine identified clinical studies that isoflavone exposure affects circulating estrogen levels in men. Clinical evidence also indicates that isoflavones have no effect on sperm or semen parameters, although only three intervention studies were identified and none were longer than 3 months in duration. Finally, findings from animal studies suggesting that isoflavones increase the risk of erectile dysfunction are not applicable to men, because of differences in isoflavone metabolism between rodents and humans and the excessively high amount of isoflavones to which the animals were exposed. CONCLUSION(S): The intervention data indicate that isoflavones do not exert feminizing effects on men at intake levels equal to and even considerably higher than are typical for Asian males.

Major hyperestrogenism in a feminizing adrenocortical adenoma despite a moderate overexpression of the aromatase enzyme.

A 30-year-old male was referred for the rapid development of gynecomastia, and dramatic hyperestrogenemia was assessed: plasma estrone, estradiol but also cortisol were not suppressed by high-dose dexamethasone, while gonadotropin pulsatility was completely abolished. A 60-mm right adrenal tumor was evidenced on computed tomography-scan, and the patient underwent adrenalectomy. The tumor was found to express a moderate increase in aromatase activity compared with adjacent non-neoplastic adrenal tissue. Quantitative RT-PCR also showed a weak and non-significant increase in total aromatase mRNA in the tumor compared with normal adrenal tissue. Aromatase transcripts were mainly promoter PII-derived, but different patterns of aromatase minor transcripts were found: promoter I.3- and I.6-derived transcripts were identified in the tumor, while only promoter I.4-derived transcripts were found in normal adrenal. This case report demonstrates that a sharp aromatase overexpression is not a prerequisite for clinical and biochemical hyperestrogenism, and further characterizes the aromatase promoter utilization in this feminizing adrenocortical tumor and in the normal adrenal cortex.

Gynaecomastia and the herbal tonic "Dong Quai".

We present a case of a man who developed gynaecomastia after ingestion of "Dong Quai" pills. "Dong Quai" is the Chinese name for the herb Angelica polymorpha var. sinensis which is widely used as a panacea for gynaecological problems, and it is also proclaimed as an invigorating tonic for both women and men. The pharmacological effects of "Dong Quai" are likely related to the phytoestrogen that it contains. This report highlights the potential adverse effects associated with its consumption in the male, especially for the processed "Dong Quai" pills which may contain significantly higher levels of phytoestrogen than its original herbal product.

Gynaecomastia with hypergonadotrophic hypogonadism and Leydig cell insufficiency in recipients of high-dose chemotherapy or chemo-radiotherapy.

Late side-effects of stem cell transplantation include hypogonadism with infertility and sexual dysfunction, but gynaecomastia is less well recognised. We report five cases of gynaecomastia with features of hypergonadotrophic hypogonadism (primary testicular failure), who received either a TBI/cyclophosphamide conditioned allograft (n = 3) or a BEAM autograft (n = 2). Patients receiving an allograft had gynaecomastia, Leydig cell insufficiency (LCI) diminished libido and erectile dysfunction. Surgery was required in one case, while in two cases the gynaecomastia resolved spontaneously after 6 months. Two patients also had gynaecomastia and sexual dysfunction, severe hypogonadism, very low testosterone levels and marked hyperprolactinaemia following autoBMT. Both responded well to testosterone replacement therapy (TRT). As a group, all patients had primary testicular failure and all except one, had LCI (compensated or frank). However, there was no correlation between the severity of gynaecomastia and the degree of endocrine dysfunction. This preliminary study is the first to suggest that gynaecomastia, due to primary hypogonadism and LCI, may be a significant complication of myeloablative conditioning therapy. Therefore gynaecomastia in BMT recipients must always be treated as a pathological entity as it may be the external manifestation of a complex endocrine pathology. It is a potentially treatable condition. Although spontaneously reversible, some patients may require TRT or even surgery. We recommend comprehensive endocrine testing in conjunction with a reproductive endocrinologist and prompt intervention to alleviate embarrassment and anxiety in afflicted BMT recipients.

Effect of gegen-tang on painful gynecomastia in patients with liver cirrhosis: a brief report.

Four patients with liver cirrhosis and complaining of painful gynecomastia were treated with oral administration of Gegen-Tang (TJ-1). Pain disappeared in 3 patients in one week, and in one patient in 4 weeks. The size of gynecomastia did not change significantly on mammography, but palpable induration diminished or disappeared. The patients had been treated with Chaihu (saiko) group drugs for liver diseases, and TJ-1 was used in combination with these drugs. Serum levels of estrogen, progesterone, testosterone, and other sex hormones did not change significantly after TJ-1 treatment. These results suggest that TJ-1 could be used for the painful gynecomastia that is occasionally seen in cirrhotic patients.

Pituitary-gonadal function in men with alcoholic cirrhosis of the liver.

Fourteen adult males with alcoholic cirrhosis were studied. Gonadotrophin responses to luteinizing hormone-releasing hormone (LRH) and testosterone (T) responses to human chorionic gonadotrophin (HCG) were determined and basal 17 beta oestradiol (E2) levels were measured in each case. The mean basal luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels, and the mean LH and FSH responses to LRH were not significantly different from a group of age-matched male controls. However, the five men with testicular atrophy all had an elevated basal FSH level and an exaggerated FSH response to LRH. The mean serum T of the cirrhotic men was significantly lower than that of the controls (P less than 0.05), while the mean E2 level was not significantly different. However, the mean E2 level in the eight patients with gynaecomastia was significantly higher than in those without gynaecomastic (P less than 0.05). All patients had a T response to HCG, including those 5 with low basal T levels. A significant negative correlation was found between the maximum rise in T after HCG (delta T) and the maximum LH response to LRH (delta LH), suggesting a mediating effect of T reserve on the LH response to LRH. These findings tend to exclude a suppressive effect of alcohol on the pituitary gland as a cause for the hypogonadism found in men with alcoholic cirrhosis. Furthermore, the evidence of some testicular T reserve despite low basal T levels, and the presence of normal basal LH levels, suggests that the low T production is not primarily due to leydig cell dysfunction.

[Coincidence of two carcinomata with excessive high level of serumestrogen (author's transl)]. / Koinzidenz zweier Karzinome mit ungewöhnlich hohem Serumöstrogenspiegel

A case of an unusual combination of a metastasing bronchus cancer, a non-metastasing cancer of prostata and an excessive high level of serum-estrogen is described. This casuistic gives rise to some more general discussion of the pathogenesis and differential diagnosis of paraneoplastic endocrinopathies.

PIP: Breast cancer was discovered in a 78-year-old man, which came from a metastasizing bronchus cancer. Investigation showed a level of serum estrogen 20 times higher than normal. This was probably due to a nonmetastasizing prostate cancer, spironalactone therapy for heart trouble, paraneoplactic endocrinopathy, and the Pierre-Marie-Bamberger syndrome.