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Gynecomastia is an enlargement of male breast resulting from a proliferation of its glandular component, and it is usually due to an altered estrogen-androgen balance. It should be differentiated from pseudogynecomastia, which is characterized by fat deposition without glandular proliferation and from breast carcinoma.
Gynecomastia could be physiological in neonates and pubertal or pathological due to drug intake, chronic liver, or renal disease, hyperthyroidism, testicular or adrenal neoplasms, and hypogonadism whether primary, or secondary. Properly organized work-up is needed to reach the cause of gynecomastia.
Gynecomastia is an enlargement of male breast resulting from a proliferation of its glandular component. It is usually benign, bilateral, and characterized by the presence of a rubbery or firm mass around the nipples.
Diseases & conditions
It usually from either increased estrogen level, increased breast sensitivity to estrogen, 1 or low testosterone level. The highest incidence of gynecomastia is reported during neonatal period, puberty, and aging due to physiological disturbances. Pseudogynecomastia, which is often seen in obese men, refers to fat deposition without glandular proliferation and should be differentiated from gynecomastia.
Therefore, male breast enlargement can be fatty pseudogynecomastia or lipomastiapure gynecomastia, or mixed. We report a year-old single man with bilateral breasts enlargement, which was noticed since the age of 15 years. At the onset, it was painful, but the pain disappeared with time. No history suggestive of headache, visual changes, testicular trauma, or systemic or sexually transmitted diseases.
Family, surgical and drug histories were unrevealing. On examination, he was obese weight Systemic examination was unremarkable apart from mild hepatomegaly. He has a little facial hair, scanty axillary and pubic hair, small and atrophic testes, and small non-buried penis.
All routine biochemical reports were within normal limits. Hormonal assay revealed hypergonadotrophic hypogonadism on the basis of low serum total testosterone, high luteinizing hormone, and high follicle stimulating hormone with normal prolactin, estradiol, thyroid stimulating hormone, cortisol, beta human chorionic gonadotrophin, and alpha fetoprotein. Abdominal and pelvic CT was normal apart from fatty liver. Scrotal ultrasound showed ificantly small testes, but with normal echotexture and shape.
Bilateral ultrasound showed enlarged breasts, very small and difficulty visualized glandular tissue, normal nipples, areola, subcutaneous and fatty tissues, and axillary regions. Bilateral mammography showed predominantly fatty tissue and there were no masses, abnormal fibroglandular tissues, calcifications, or axillary lymph nodes. Semen analysis showed Azoospermia.
Gynecomastia was classified by Simon into several based on the size of the breast and skin redundancy. Furthermore, the prevalence of gynecomastia increases with an increase in the body mass index, probably due to the paracrine effects of estradiol produced by subareolar fat on glandular expansion.
Our patient is obese and has and Grade 3 mixed gynecomastia. His little facial hair guided us to carry out complete examination and further work-up, which revealed scanty axillary and pubic hair, small and atrophic testes, small penile size, eunuchoidal build arm span longer than heightand hypergonadotrophic hypogonadism. Before puberty, usually, no findings can be detected although slightly smaller testicular breast is sometimes noticed.
However, after puberty, KS presents with s and symptoms of androgen deficiency and infertility. In conclusion, KS is the most common genetic cause of human male infertility and should be considered in patients with gynecomastia and hypogonadism. Many cases are missed due to poor clinical suspicion, diverse clinical presentation, and difficult accessibility of cytogenetic analysis in some countries.
Early diagnosis and hormonal replacement can virtually improve the quality of life and prevent serious complications. We highlight this case because our patient is obese and breast enlargement could be explained as pseudogynecomastia, and this low suspicion index may interfere with further diagnostic work-up.
Authors have no conflict of interests, and the work was not supported or funded by any drug company. Case reports will only be considered for unusual topics that add something new to the literature. All Case Reports should include at least one figure.
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The abstract should be unstructured, and the introductory section should always include the objective and reason why the author is presenting this particular case. References should be up to date, preferably not exceeding National Center for Biotechnology InformationU. Journal List Saudi Med J v.
Saudi Med J. Salim S. Al Qassabi. Saud M. Magdi E. Author information Article notes Copyright and information Disclaimer.
Procedures & tests
Address correspondence and reprint request to: Dr. E-mail : moc. Received Mar 8; Accepted Jun This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.
This article has been cited by other articles in PMC. Abstract Gynecomastia is an enlargement of male breast resulting from a proliferation of its glandular component, and it is usually due to an altered estrogen-androgen balance. Case Report We report a year-old single man with bilateral breasts enlargement, which was noticed since the age of 15 years. Open in a separate window.
A photograph of an obese male with bilateral breast enlargement. Discussion Gynecomastia was classified by Simon into several based on the size of the breast and skin redundancy.
Footnotes Disclosure. Case Reports.
Puberty: it's not one size fits all
References 1. Glass AR. Endocrinol Metab Clin North Am. Surgical treatment of gynaecomastia. Incidence of gynaecomastia in young males and its relationship to somatometric parameters. Ann Hum Biol.
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Abramsky L, Chapple J. Prenat Diagn. Klinefelter syndrome. Arch Intern Med. Birth of healthy male twins after intracytoplasmic sperm injection of frozen-thawed testicular spermatozoa from a patient with nonmosaic Klinefelter syndrome.