Which conditions may cause gynecomastia?

Updated: Mar 22, 2018
  • Author: George Ansstas, MD; Chief Editor: George T Griffing, MD  more...
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The following are some of the conditions associated with gynecomastia:

  • Klinefelter syndrome

  • Congenital anorchia

  • Testicular trauma

  • Viral orchitis

  • Kallmann syndrome: A form of hypogonadotropic hypogonadism, Kallmann syndrome is usually associated with varying degrees of abnormality in olfactory perception; this results from the defective migration of gonadotropin-releasing hormone–secreting cells (which co-migrate with the cells of the olfactory epithelium) during embryogenesis.

  • Pituitary tumors or abnormalities such as the ones that lead to either hypersecretion or hyposecretion of LH

  • Malignancies that increase the serum level of hCG (eg, large cell lung cancer, gastric carcinoma, renal cell carcinoma, hepatoma) [6]

  • Renal failure: Men with end-stage renal disease may have reduced testosterone and elevated gonadotropin values. This apparent primary testicular failure may then lead to increased breast development. [6]

  • Hyperthyroidism: Gynecomastia seen with hyperthyroidism is due to increased aromatase activity and increased levels of SHBG. SHBG binds androgens more avidly than estrogen, allowing for higher free levels to act on peripheral tissues such as the breast.

  • Malnutrition: Gynecomastia seen with malnutrition and starvation is probably due to reduced gonadotropin and testosterone levels relative to estrogen and may worsen with refeeding, owing to a rise in estradiol production that outpaces the increases in gonadotropin and testosterone.

  • Environmental pollutants: The most likely mechanism is through estrogen receptor binding and activation.

  • Androgen insensitivity syndrome

  • Aromatase excess syndrome: Familial prepubertal gynecomastia is a rare autosomal dominant inherited disorder that results in an excess estrogen state due to increased aromatase activity. This disorder appears to be due to heterozygous inversion or polymorphisms of the P450 aromatase gene. The phenotypic picture was described in an 8-year-old boy with accelerated growth and bone maturation with severe feminization and gynecomastia due to high rate conversion of plasma androstenedione to estrone. [16]

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