Hippokratia 2004; 8(1):11-18
M Somali, M. Kontopoulos
Endocrinology Dpt, Hippokratio General Hospital, Thessaloniki, Greece
Gynaecomastia is the most frequent benign condition of the male breast with a frequency 40% to 66% in adults and 30% to 66% in adolescents. The histologic features of gynaecomastia consist of benign enlargement and proliferation of the mammary gland constituents. Clinically it is described as a bilateral, palpable discoid enlargement of the breast tissue beneath the areola, usually tender and symmetrical. Physiological enlargement of the male breast is seen in newborns, during adolescence and in healthy elderly men. In pathologic states gynaecomastia can be caused by a deficiency of testosterone formation or action, enhanced estrogen production or drugs. In idiopathic gynaecomastia no underlying endocrinopathy is revealed. A careful physical examination supported by an endocrine work-up and the use of imaging techniques usually reveals the cause and rule out the possibility of estrogen producing neoplasms. Mammography and fine needle aspiration biopsy are considered in cases where breast cancer is suspected. Androgens (dihydrotestosterone and danazol), antiandrogens (tamoxifen and clomiphene) and reductase inhibitors (anastrozole and letrozole) have been used in the treatment of pathologic gynaecomastia of recent onset with ambiguous results. Corrective surgery offers treatment where pharmacologic manipulation has failed, in long standing gynaecomastia for aesthetic reasons and in suspected breast cancer.