Keywords
cancer de seno en hombres
adolescente
obesidad
estrogenos
testosterona
tamoxifeno
aromatasa
cáncer de próstata
Gynecomastia
male breast cancer
adolescents
obesity
estrogens
testosterone
tamoxifen
aromatase
prostate cancer
How to Cite
Abstract
Introducción: La ginecomastia es la proliferación benigna, en el hombre, del tejido glandular mamario que se encuentra debajo del pezón, detrás de la areola. Es necesario diferenciar la pseudoginecomastia de la verdadera, y en ésta, la fisiológica de la patológica.
Métodos: Se hizo una revisión de algunas bases de datos en relación con la ginecomastia patológica, factores endocrinos que influencian el crecimiento mamario masculino, diagnóstico diferencial, proceso diagnóstico y, finalmente, el tratamiento en los casos que así lo requerían. Se buscaron artículos en el periodo 2000-2016.
Resultados: Para resolver la pregunta clínica, en PubMed se encontraron 55 artículos de revisión, y un estudio clínico. En SciELO se encontraron 14 resúmenes de revisiones o series de casos correspondientes a países latinoamericanos. De Colombia, se encontraron 2 artículos. En Lilacs, fueron 6 con las mismas características. Algunos artículos se encontraron repetidos en las bases de datos. En Cochrane, no había referencias sobre el tema.
Discusión: La verdadera ginecomastia es una entidad benigna que pocas veces necesita estudios adicionales. Debe diferenciarse de la pseudoginecomastia, acumulación de grasa subareolar sin proliferación de tejido glandular mamario. Diversas enfermedades se asocian con ginecomastia, particularmente el hipogonadismo, tanto primario como secundario, los síndromes de resistencia androgénica, el hipertiroidismo, la cirrosis hepática y la ingesta de algunos medicamentos. Después de confirmar el diagnóstico, buscando la causa y clasificando la severidad, el manejo debe ser individualizado.
Abstract
Introduction: Gynecomastia is the benign proliferation of glandular breast tissue in the male, beneath the nipple (subareolar region). Once pseudogynecomastia is ruled out, cases can be classified in physiologic, pharmacologic and pathologic gynecomastia.
Methods: This paper also accounts for a nonsystematic review of some databases in regard to pathologic gynecomastia, factors that influence breast enlargement in the male, differential diagnosis, process of diagnostic investigation and finally, treatment when needed. Searched papers were published between 2000-2016.
Results: To answer clinical question, 55 review articles and a clinical trial were found in Medline, 14 review papers and case reports in SciELO (2 from Colombia), 6 in LILACS, with same characteristics. No reports were found in Cochrane.
Discussion: True gynecomastia is a benign condition than seldom needs additional work-up. A pseudogynecomastia must be ruled out. Several medical conditions are associated with gynecomastia such as primary or secondary gonadal failure, androgen resistance syndromes, hyperthyroidism, chronic liver disease, and the use of some medications. Once diagnosis is confirmed (searching for etiology, staging severity), management should be tailored to each patient.
References
2. Nuttall FQ. Gynecomastia as a physical finding in normal men. J Clin Endocrinol Metab. 1979; 48(2):338-40.
3. Bocchinfuso WP, Korach KS: Mammary Gland Development and Tumorigenesis in Estrogen Receptor Knockout Mice. Journal of Mammary Gland Biology and Neoplasia 1997; 90: 323-334.
4. Walden PD, Ruan W, Feldman M, Kleinberg DL: Evidence that the Mammary Fat Pad Mediated the Action of Growth Hormone in Mammary Gland Development, Endocrinology 139 (2): 659-62, 1998.
5. Mieritz MG, Sorensen K, Aksglaede L et al. Elevated serum IGF-I, but unaltered sex steroid levels, in healthy boys with pubertal gynaecomastia. Clin Endocrinol (Oxf ). 2014;80(5):691-8.
6. LeProvost F, Leroux, C, Martin P Gaye P, Djiane, J, Prolactin Gene Expression in Ovine and Caprine Mammary Gland, Neuroendocrinology 60: 305-313, 1994.
7. Carlson HE, Kane P, Lei ZM, et al: Presence of luteinizing hormone/human chorionic gonadotropin receptors in male breast tissues. J Clin Endocrinol Metab 89(8):4119-23, 2004.
8. Thaler MA, Seifert-Klauss V, Luppa PB. The biomarker sex hormone-binding globulin - from established applications to emerging trends in clinical medicine. Best Pract Res Clin Endocrinol Metab. 2015;29(5):749-60.
9. Swerdloff RS, Ng JCM. Gynecomastia: Etiology, Diagnosis, and Treatment. In: De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-2015 Aug 3.
10. Barón-Castañeda G, Jácome-Roca A. Aparato reproductor femenino y ciclo menstrual. En Fisiología Endocrina (A. Jácome-Roca, E. Ardila, LA Casas, Eds.), 2017. 4ª. Edición, Ed. Manual Moderno, Bogotá.
11. Trost LW, Serefoglu E, Gokce A, Linder BJ, Sartor AO, Hellstrom WJ. Androgen deprivation therapy impact on quality of life and cardiovascular health, monitoring therapeutic replacement. J Sex Med. 2013;10 Suppl 1:84-101.
12. Fagerlund A, Lewin R, Rufolo G, Elander A, Santanelli di Pompeo F, Selvaggi G. Gynecomastia: A systematic review. J Plast Surg Hand Surg. 2015;49(6):311-8.
13. Ismail AA, Barth JH. Endocrinology of gynaecomastia. Ann Clin Biochem. 2001; 38(Pt 6):596-607.
14. Niewoehner CB, Nuttal FQ. Gynecomastia in a hospitalized male population. Am J Med. 1984;77:633-638.
15. Nordt CA, DiVasta AD. Gynecomastia in adolescents. Curr Opin Pediatr. 2008;20:375–382
16. Carlson HE. Approach to the patient with gynecomastia. J Clin Endocrinol Metab 2011; 96 (1):15-21.
17. Amer A, Fischer H. Neonatal Breast Enlargement. N Engl J Med 2009; 360:1445
18. Raveenthiran V. Neonatal Mastauxe (Breast Enlargement of the Newborn). Neonatal Surg. 2013; 2(3): 31.
19. Johnson RE, Hassan-Murad M. Gynecomastia: Pathophysiology, Evaluation, and Management. Mayo Clin Proc. 2009; 84 (11): 1010–1015.
20. Georgiadis E, Papandreou L, Evangelopoulou C, et al. Incidence of gynaecomastia in 954 young males and its relationship to somatometric parameters. Ann Hum Biol. 1994;21:579–58.
21. Rew L, Young C, Harrison T, Caridi R. A systematic review of literature on psychosocial aspects of gynecomastia in adolescents and young men. J Ado- lesc. 2015; 43:206-12.
22. Abaci A, Buyukgebiz A. Gynecomastia: review. Pediatr Endocrinol Rev. 2007; 5(1):489-99.
23. Barros AC, Sampaio M de C. Gynecomastia: physiopathology, evaluation and treatment. Sao Paulo Med J. 2012;130(3):187-97.
24. Kumanov P, Deepinder F, Robeva R, Tomova A, Li J, Agarwal A. Relationship of adolescent gynecomastia with varicocele and somatometric parameters: a cross-sectional study in 6200 healthy boys. J Adolesc Health. 2007; 41(2):126-31.
25. Daniels IR, Layer GT. Gynaecomastia. Eur J Surg. 2001 Dec;167(12):885-92.
26. Rahnema CD, Lipshultz LI, Crosnoe LE, Kovac JR, Kim ED. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril. 2014; 101(5):1271-9.
27. Basaria S. Androgen abuse in athletes: detection and consequences. J Clin Endocrinol Metab. 2010;95(4):1533-43.
28. Luis D, Aller R, Cuéllar LA, Terroba C, Romero E. Anabolizantes esteroideos y ginecomastia: Revisión de la literatura. An Med Int. 2001; 18 (9): 45-47.
29. Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, et al. Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev. 2009; 30(4):293-342.
30. Braunstein GD. Environmental gynecomastia. Endocr Pract. 2008;14(4):409-11.
31. Durmaz E, Ozmert EN, Erkekoglu P, et al. Plasma phthalate levels in pubertal gynecomastia. Pediatrics. 2010;125(1):e122-9.
32. Eckman A, Dobs A. Drug-induced gynecomastia. Expert Opin Drug Saf. 2008; 7(6):691-702.
33. Goldman RD. Drug-induced gynecomastia in children and adolescents. Can Fam Physician. 2010 ;56(4):344-5.
34. Nuttall FQ, Warrier RS, Gannon MC. Gynecomastia and drugs: a critical evaluation of the literature. Eur J Clin Pharmacol. 2015;71(5):569-7.
35. Krause W. Drug-inducing gynaecomastia--a critical review. Andrologia. 2012 May;44 Suppl 1:621-6.
36. Deepinder F, Braunstein GD. Drug-induced gynecomastia: an evidence- based review. Expert Opin Drug Saf. 2012; 11(5):779-95.
37. Sauer MA, Rifka SM, Hawks RL, Cutler GB Jr, Loriaux DL. Marijuana: interaction with the estrogen receptor. J Pharmacol Exp Ther. 1983;224(2):404-7.
38. Narula HS, Carlson HE. Gynecomastia. Endocrinol Metab Clin North Am. 2007;36(2):497-519.
39. Lanfranco F, Kamischke A, Zitzmann M, Nieschlag E. Klinefelter’s syndrome. Lancet. 2004;364(9430):273-83.
40. Forga L, Anda E, Martínez de Esteban JP. Paraneoplastic hormonal syndromes. An Sist Sanit Navar. 2005; 28(2):213-26.
41. Ponce de León Roca J, Algaba Arrea F, Bassas Arnau L, Villavicencio Mavrich H. Leydig cell tumor of the testis. Arch Esp Urol. 2000; 53(6):453-8.
42. Harle LK, Maggio M, Shahani S, Braga-Basaria M, Basaria S. Endocrine complications of androgen-deprivation therapy in men with prostate cancer. Clin Adv Hematol Oncol. 2006;4(9):687-96.
43. Hassan HC, Cullen IM, Casey RG, Rogers E. Gynaecomastia: an endocrine manifestation of testicular cancer. Andrologia. 2008;40(3):152-7.
44. Meikle AW. The interrelationships between thyroid dysfunction and hypogonadism in men and boys. Thyroid. 2004;14 Suppl 1:S17-25.
45. Zajac JD, Fui MN. Kennedy’s disease: clinical significance of tandem repeats in the androgen receptor. Adv Exp Med Biol. 2012;769:153-68.
46. García-Benayas T, Blanco F, Martín-Carbonero L, et al. Gynecomastia in HIV- infected patients receiving antiretroviral therapy. AIDS Res Hum Retroviruses. 2003;19(9):739-4.
47. Fagerlund A, Cormio L, Palangi L, Lewin R, Santanelli di Pompeo F, Elander A, Selvaggi G. Gynecomastia in Patients with Prostate Cancer: A Systematic Review. PLoS One. 2015;10(8):e0136094.
48. Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet. 2006; 367(9510):595-604.
49. Hines SL, Tan WW, Yasrebi M, DePeri ER, Perez EA. The role of mammography in male patients with breast symptoms. Mayo Clin Proc. 2007; 82(3):297-30.
50. Olsson H, Bladstrom A, Alm P. Male gynecomastia and risk for malignant tumours--a cohort study. BMC Cancer. 2002; 2:26.
51. Ordaz DL, Thompson JK. Gynecomastia and psychological functioning: A review of the literature. Body Image. 2015; 15:141-8.
52. Rew L, Young C, Harrison T, Caridi R. A systematic review of literature on psychosocial aspects of gynecomastia in adolescents and young men. J Adolesc. 2015; 43:206-12.
53. Innocenti A, Melita D, Mori F, Ciancio F, Innocenti M. Management of Gynecomastia in Patients with Different Body Types: Considerations on 312 Consecutive Treated Cases. Ann Plast Surg. 2016 Nov 1. [Epub ahead of print]
54. Marilho Tadeu Dornelas MT, Carvalho-Machado D et al. Surgical treatment of gynecomastia: a critical analysis. Rev Bras Cir Plást. 2010; 25 (3): 470- 473.
55. Handschin AE, Bietry D, Hüsler R, Banic A, Constantinescu M. Surgical management of gynecomastia—a 10-year analysis. World J Surg. 2008; 32(1):38-44 .
56. Hammond DC. Surgical correction of gynecomastia. Plast Reconstr Surg. 2009;124(1 Suppl):61e-68e
57. Lapid O, van Wingerden JJ, Perlemuter L. Tamoxifen therapy for the management of pubertal gynecomastia: a systematic review. J Pediatr Endocrinol Metab. 2013; 26(9-10):803-7.
58. Devoto C, Enzo; Madariaga A, Marcia; Lioi C, Ximena; Mardones, Nelly. Terapia médica de la ginecomastia con tamoxifeno. Influencia del volumen y duración de la ginecomastia en el resultado terapéutico. Rev Méd Chile, 2007; 135 (12): 1558 – 1565.
59. Costanzo, PR; Suárez, S; Aszpis, SM; Stewart Usher, JG; Pragier, UM; Vásquez Cayoja, M; Iturrieta, S; Knoblovits, P; Pacenza, NA. Ginecomastia: aspectos clínicos y etiológicos. Estudio retrospectivo y multicéntrico Rev Arg Endocrinol Metab, 2015; 52 (1): 22 - 28.
60. Devoto C, Enzo; Madariaga A, Marcia; Aravena, Lucía; Lioi C, Ximena. Etiología de la ginecomastía: Importancia de no subdiagnosticar una ginecomastia patológica. Rev Méd Chile, 2007; 135 (2): 189 - 197.
61. Man Z, Sánchez A, Carretto H, Parma R. Tratamiento de la Ginecomastia con Raloxifeno. Rev Argent Endocrinol Metab. 2003;40:8 -11.
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