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Gynaecomastia

Disease Details

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Description: Gynecomastia is the benign enlargement of male breast tissue due to an imbalance of estrogen and testosterone levels.
Type: Gynaecomastia is not a disease with a specific genetic transmission pattern. It is a condition characterized by the benign enlargement of breast tissue in males. While genetic factors can sometimes play a role, gynaecomastia can also result from hormonal imbalances, medication use, underlying health conditions, or idiopathic causes. There is no single mode of genetic transmission for this condition.
Signs And Symptoms: In gynecomastia there is always enlargement of one or both breasts, symmetrically or asymmetrically, in a man. A soft, compressible, and mobile mass of breast tissue is felt under the nipple and its surrounding skin in contrast to softer fatty tissue which is not associated with a mass. It may also be accompanied by breast tenderness or nipple sensitivity, which is commonly associated with gynecomastia observed in adolescents, typically early in development. Gynecomastia that is painful, bothersome, rapidly-growing, associated with masses in other areas of the body, or persistent should be evaluated by a clinician for potential causes. Dimpling of the skin, nipple discharge, and nipple retraction are not typical features of gynecomastia and may be associated with other disorders. Milky discharge from the nipple is not a typical finding, but may be seen in a gynecomastic individual with a prolactin secreting tumor. An increase in the diameter of the areola and asymmetry of the chest are other possible signs of gynecomastia.Gynecomastia has psychosocial implications that may be particularly challenging for adolescents who are experiencing physical maturation and self-identity formation, which includes body image disturbances, negative attitudes towards eating, self-esteem problems, social withdrawal, anxiety, and shame. Men with gynecomastia may appear anxious or stressed due to concerns about its appearance and the possibility of having breast cancer.
Prognosis: Gynecomastia itself is a benign finding. It does not confer a poor prognosis, for some patients with underlying pathologies such as testicular cancer the prognosis may be worse. The glandular tissue typically grows under the influence of hormonal stimulation and is often tender or painful. Furthermore, gynecomastia frequently presents social and psychological difficulties such as low self-esteem, depression or shame.
Onset: Gynecomastia onset refers to the period when symptoms first appear. It can occur at various life stages:

1. Neonatal: Due to maternal estrogen, often resolves within weeks.
2. Pubertal: Common in boys aged 10-14, usually regresses within 6 months to 2 years.
3. Adult: Mainly in men over 50, often linked to hormonal changes, medications, or underlying conditions.
Prevalence: Gynaecomastia occurs in approximately 32-65% of males at some point in their lives, with the prevalence varying based on age and underlying health conditions. It is most common during three specific periods: neonatal, pubertal, and older age.
Epidemiology: Gynecomastia is the most common benign disorder of the male breast tissue and affects 35 percent of men, being most prevalent between the ages of 50 and 69.New cases of gynecomastia are common in three age populations: newborns, adolescents, and men older than 50 years. Newborn gynecomastia occurs in about 60–90 percent of male babies and most cases resolve on their own in about 2–3 weeks after delivery. During adolescence, on average 33 percent of males are estimated to exhibit signs of gynecomastia. Gynecomastia in older men is estimated to be present in 24–65 percent of men between the ages of 50 and 80. Estimates on asymptomatic gynecomastia is about up to 70% in men aged 50 to 69 years.The prevalence of gynecomastia in men may have increased in recent years, but the epidemiology of the disorder is not fully understood. The use of anabolic steroids and exposure to chemicals that mimic estrogen in cosmetic products, organochlorine pesticides, and industrial chemicals have been suggested as possible factors driving this increase. According to the American Society of Plastic Surgeons, breast reduction surgeries to correct gynecomastia are fairly common but has been a recent decline. In 2020, there were over 18,000 procedures of this type performed in the United States which is down 11% compared to in 2019.
Intractability: Gynaecomastia, which refers to the enlargement of male breast tissue, is generally not considered an intractable condition. It can often be treated effectively depending on the underlying cause. Treatment options include medication to address hormonal imbalances, lifestyle changes, and in some cases, surgical intervention such as liposuction or mastectomy to remove excess tissue.
Disease Severity: Gynaecomastia is characterized by the benign enlargement of male breast tissue. Its severity can vary from mild to severe, based on the degree of breast enlargement and any associated physical or psychological discomfort. It is not considered life-threatening but can impact quality of life. Prompt medical evaluation is recommended to rule out underlying conditions and to discuss potential treatment options.
Healthcare Professionals: Disease Ontology ID - DOID:12698
Pathophysiology: The causes of common gynecomastia remain uncertain, but are thought to result from an imbalance between the actions of estrogen, which stimulates breast tissue growth, and androgens, which inhibit breast tissue growth. Breast prominence can result from enlargement of glandular breast tissue, chest adipose tissue (fat) and skin, and is typically a combination. As in females, estrogen stimulates the growth of breast tissue in males. In addition to directly stimulating breast tissue growth, estrogens indirectly decrease secretion of testosterone by suppressing luteinizing hormone secretion, resulting in decreased testicular secretion of testosterone.
Carrier Status: Gynaecomastia is the benign enlargement of male breast tissue, commonly caused by an imbalance of estrogen and testosterone. Carrier status is not applicable to this condition, as it is not typically a genetic disorder inherited like other diseases. Instead, it is more often related to hormonal changes, medications, or other underlying health conditions.
Mechanism: Gynaecomastia is the benign enlargement of male breast tissue, typically caused by an imbalance between estrogen and androgen levels. Here’s a concise breakdown:

**Mechanisms:**
1. **Hormonal Imbalance:** An increase in estrogen activity or a decrease in androgen activity leads to the proliferation of glandular tissue in the male breast.
2. **Medications:** Certain drugs can cause gynaecomastia by altering hormone levels or acting directly on breast tissue.
3. **Health Conditions:** Disorders such as liver disease, kidney failure, and hyperthyroidism can interfere with the normal metabolism of hormones, leading to gynaecomastia.

**Molecular Mechanisms:**
1. **Estrogen Receptor Activation:** Estrogens bind to estrogen receptors (ERα and ERβ) in breast tissue, triggering gene expression that promotes the growth and development of glandular tissue.
2. **Androgen Receptor Inhibition:** Reduced androgen activity (due to low levels of testosterone or androgen receptor antagonism) decreases the inhibitory effect on breast tissue growth.
3. **Aromatase Activity:** Increased aromatase enzyme activity can convert androgens (like testosterone) into estrogens, increasing local estrogen levels in breast tissue.
4. **Apoptosis and Cell Proliferation:** Imbalances in these processes can favor the survival and proliferation of glandular cells in the breast tissue, contributing to enlargement.

Understanding these mechanisms highlights the complex interplay of hormones and cellular pathways involved in the development of gynaecomastia.
Treatment: If the gynecomastia doesn't resolve on its own in two years, then medical treatment is necessary. The options are medication or surgical intervention.
Compassionate Use Treatment: For gynecomastia, compassionate use treatment and off-label or experimental treatments may include:

1. **Compassionate Use Treatments:**
- **Selective Estrogen Receptor Modulators (SERMs):** Drugs such as tamoxifen and raloxifene, typically used for breast cancer, are sometimes provided under compassionate use for severe gynecomastia.

2. **Off-label or Experimental Treatments:**
- **Aromatase Inhibitors:** Medications like anastrozole and letrozole, designed to reduce estrogen production, are occasionally used off-label for gynecomastia.
- **Androgens:** Medications such as danazol, which is a synthetic androgen, might be used off-label to balance hormonal levels.
- **Testosterone Replacement Therapy:** In cases where gynecomastia is due to testosterone deficiency, testosterone replacement might be considered off-label.

It's important to consult with a healthcare provider to discuss the risks, benefits, and appropriateness of these treatments for individual cases.
Lifestyle Recommendations: For gynecomastia, consider the following lifestyle recommendations:

1. **Healthy Diet**: Consume a balanced diet rich in fruits, vegetables, lean proteins, and whole grains to maintain a healthy weight.
2. **Exercise Regularly**: Incorporate both cardiovascular exercises and strength training to reduce overall body fat and build chest muscles.
3. **Avoid Alcohol and Drugs**: Limit alcohol consumption and avoid using recreational drugs, as they can exacerbate hormonal imbalances.
4. **Check Medications**: Review current medications with a healthcare provider, as some drugs can lead to gynecomastia.
5. **Manage Stress**: Practice stress-reducing techniques such as yoga, meditation, or deep breathing exercises to help balance hormones.
6. **Avoid Anabolic Steroids**: Steer clear of anabolic steroids and hormone-containing supplements, as they can cause or worsen gynecomastia.

Adhering to these lifestyle changes can help manage and potentially reduce the symptoms of gynecomastia.
Medication: Medications are known to cause gynecomastia through several different mechanisms. These mechanisms include increasing estrogen levels, mimicking estrogen, decreasing levels of testosterone or other androgens, blocking androgen receptors, increasing prolactin levels, or through unidentified means. Potential causative agents include oral contraceptive pills, spironolactone, and anabolic steroids.High levels of prolactin in the blood (which may occur as a result of certain tumors or as a side effect of certain medications) has been associated with gynecomastia. A high level of prolactin in the blood can inhibit the release of gonadotropin-releasing hormone and therefore cause secondary hypogonadism. Receptors for prolactin and other hormones including insulin-like growth factor 1, insulin-like growth factor 2, luteinizing hormone, progesterone, and human chorionic gonadotropin have been found in male breast tissue, but the impact of these various hormones on gynecomastia development is not well understood.Gynecomastia can respond well to medical treatment although it is usually only effective when done within the first two years after the start of male breast enlargement. Selective estrogen receptor modulators (SERMs) such as tamoxifen, raloxifene, and clomifene may be beneficial in the treatment of gynecomastia but are not approved by the Food and Drug Administration for use in gynecomastia. Clomifene seems to be less effective than tamoxifen or raloxifene. Tamoxifen may be used to treat gynecomastia in adults and of the medical treatments used, tamoxifen is the most effective. Recent studies have shown that treatment with tamoxifen may represent a safe and effective mode of treatment in cases of cosmetically disturbing or painful gynecomastia. Aromatase inhibitors (AIs) such as anastrozole have been used off-label for cases of gynecomastia occurring during puberty but are less effective than SERMs.A few cases of gynecomastia caused by the rare disorders aromatase excess syndrome and Peutz–Jeghers syndrome have responded to treatment with AIs such as anastrozole. Androgens/anabolic steroids may be effective for gynecomastia. Testosterone itself may not be suitable to treat gynecomastia as it can be aromatized into estradiol, but nonaromatizable androgens like topical androstanolone (dihydrotestosterone) can be useful.
Repurposable Drugs: Several repurposable drugs have been studied and used to treat gynecomastia, a condition characterized by the enlargement of male breast tissue. These include:

1. **Tamoxifen**: A selective estrogen receptor modulator (SERM) originally used to treat breast cancer.
2. **Raloxifene**: Another SERM, also used to prevent osteoporosis in postmenopausal women.
3. **Anastrozole** and **Letrozole**: Aromatase inhibitors typically used in breast cancer treatment.
4. **Clomiphene**: A SERM used primarily for treating infertility.

These drugs aim to counteract the effects of estrogen, which can contribute to breast tissue growth in males.
Metabolites: Gynaecomastia can be influenced by various metabolites and hormonal imbalances. Key metabolites include:

1. **Estradiol**: An increase in estradiol (a form of estrogen) relative to testosterone can promote breast tissue growth.
2. **Testosterone**: Low levels of testosterone can lead to a relative increase in the effects of estrogen.
3. **Androstenedione**: This steroid hormone can convert to estrogen, potentially contributing to gynaecomastia if its levels are high.
4. **Dihydrotestosterone (DHT)**: Reduced conversion of testosterone to DHT can diminish androgenic effects, favoring estrogenic action.

In the case of "nan," if you're referring to 'N-Acetylcysteine (NAC)' or another specific nanomaterial or nanoparticle treatment, clarification is needed as it is not standard terminology related to the known causes or treatments of gynaecomastia.
Nutraceuticals: Gynaecomastia, the benign enlargement of male breast tissue, has limited evidence supporting the efficacy of nutraceuticals for its treatment. While some nutraceuticals like green tea extract, flaxseed, and certain vitamins (e.g., Vitamin D) are occasionally claimed to help, robust clinical evidence is lacking. Conventional treatments include addressing the underlying cause, hormonal therapy, or surgical options.
Peptides: Gynaecomastia is the benign enlargement of male breast tissue, often due to hormonal imbalances, medications, or other health conditions. The term "peptides" refers to short chains of amino acids that may influence various physiological processes, including hormone regulation, but their role in gynaecomastia is not well established. "Nan" likely refers to nanotechnology, which involves the manipulation of matter on an atomic or molecular scale, but its application in treating gynaecomastia is still in the experimental stages and not part of standard medical practice.