BREAST ENLARGEMENT (GYNECOMASTIA)
Editor - Pediatric Oncall
Some boys tend to get enlargement of breast especially during their teens. What is it?
Breast enlargement often occurs in boys during the time of puberty. It is called as gynecomastia (pronounced as guy-nae-co-mast-e-a). This is due to increased estrogen hormones which may occur at time of puberty. It is a normal phenomenon and the breast usually regresses on its own.
Gynecomastia is commonly found in one breast. Is that normal?
Asymmetry in the development of gynecomastia is common and may often precede the enlargement of breast on both sides.
At what age does gynecomastia usually occur in boys?
Between 10 and 16 years of age, about 40% of boys develop transient gynecomastia. This gynecomastia at the time of puberty spontaneously disappears in about 75% of boys within 2 years and in about 90% of boys in 3 years.
Why does this breast enlargement occur in boys?
Androgen hormones in boys are converted to estrogen in muscles, fat and skin. In the early stages of puberty, the pituitary gland stimulates the tests to secrete testosterone only at night. As puberty advances, circulating gonadotropin and testosterone levels rise during day times as well. In contrast, estrogen that is derived from androgens begins to rise throughout the 24 hour day in early adolescence. Testosterone suppresses the action of estrogen. As a result testosterone suppression of estrogen action on breast tissue is in effect at night but not in afternoon and evening in early adolescence. Thus, increased conversion of androgens to estrogens can cause transient breast enlargement in boys.
What are other causes of gynecomastia?
Sometimes gynecomastia can occur due to other causes such as ingesting estrogens in drugs, use of androgens, administration of HCG hormone to boys, using anti depressants, anti TB medications such as INH, ethionamide and anti cancer drugs.
Sometimes gynecomastia may be associated with hormonal problems such as defects in testosterone synthesis, Klinefelter syndrome, injury to testis, hyperthyroidism, liver disease, malnutrition, cancer of testis or pituitary gland.
How to differentiate between gynecomastia due to puberty and non-pubertal gynecomastia?
Gynecomastia due to puberty is usually seen between 10-16 years of age whereas gynecomastia due to non-pubertal causes is usually seen before 10 years of age and there may be associated with other diseases or there may be history of drug ingestion. Your doctor will examine the child and determine the differentiation clinically.
Are any laboratory tests required to diagnose gynecomastia?
For gynecomastia due to puberty, usually no laboratory tests are required. For gynecomastia due to other causes, your doctor may order tests based on clinical examination and suspected cause.
What is the treatment of gynecomastia?
Adolescent boys with breast enlargement due to puberty with size less than 4cm usually need no treatment. In 90% of cases, gynecomastia will disappear within 3 years without treatment. However for breast size more than 6 cm, anti estrogen drugs may be required. If gynecomastia is present for 4 years or more and has become firm, then surgery may be required.
Treatment of non-pubertal gynecomastia consists of correcting the underlying cause.
Last updated on 1-7-2010