Introduction and Aim: Pubertal gynecomastia is the transient proliferation of glandular tissue in breasts of men without any endocrin pathology. Relatively higher levels of estrogen than plasma testosteron levels and imbalance between tissue estrogen and testosteron levels are considered to be important in pathogenesis. In this study it is aimed to determine the clinical and laboratory properties of our patients who were diagnosed as pubertal gynecomastia and compare with healthy population.
Material and method: 39 healthy adolescent boys and 39 adolescent boys diagnosed as pubertal gynecomastia in our clinic between July 2015 and January 2018 were evaluated retrospectively. Age, puberty, weight, height, body mass index and standard deviations, LH, FSH, estradiol (E2), total testosteron, TSH, fT4, prolactin, alpha fetoprotein (AFP), β-HCG, AST, ALT, BUN, creatinin levels of both groups were detected, E2/T rate calculated, and differences between two groups were determined. Breast glanduler tissue diameters measured ultrasonographically in gynecomastia group was noted, family history, drug usage and comorbidities were evaluated.
Results: Mean age was 13.7±1.6 (10.216.8) in pubertal gynecomastia group and 13.6±1.9 (10.017.5) in control group, no differences determined between two groups (P=0.748). Weight, height and BMI SDS were similar in two groups (P=0.696, P=0.541, P=0.461, respectively). Mean puberty phase was 4 (2-5) with no difference between groups (P=0.361). Similarly, there was no difference in LH, FSH, TSH, fT4, AST, ALT, BUN, creatinin, AFP and β-HCG levels (P>0.05), but T and E2 levels and E2/T rate was higher in gynecomastia group with no statistical difference (P=0.389, P=0.07, P=0.116, respectively). Prolactin levels were normal but higher in gynecomastia group (P=0.015). In gynecomastia group, right breast glanduler tissue diameter was 1.88±0.88 (0.64.1) cm and 1.95±1.02 (0.63.6) cm in left breast, there was statistically difference between two breasts (P<0.01). 71.7% of gynecomastia patients (n=28) were bilateral. Plasma T levels was lower and E2/T rate was higher in patients with bilateral gynecomastia than with unilateral gynecomastia (P=0.02, P=0.01, respectively). Mean complaint duration was 18.6±25.2 (1-104) weeks, 10.3% (n=4) had family history, 7.7% (n=3) had drug usage and 12.8% (n=5) had comorbidities.
Conclusion: We determined that there is no difference in E2 levels ve E2/T rate between gynecomastia patients and control group. Therefore, it is considered that increased estrogen sensitivity of breast tissue takes role rather than increased estrogen levels or imbalance between estrogen and testosteron.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology