The term "true" gynecomastia distinguishes itself from more common pseudo gynecomastia which is to have breast tissues due to overweight and obesity or other causes like reaction to some drugs, is not temporary and persists without any glandular presence whatsoever. Subcutaneous fatty cells tend to accumulate in the chest area making it appear like gynecomastia and male breasts so it is called so, but clinically the causes and symptoms of both are different, and some physicians do not consider pseudo gynecomastia as a term in medical literature.
Gynecomastia is one of the most common breast problems in men and was first described by Paulus Aegineta (AD 625-690), who thought it was due to formation of fat. It can occur due to numerous causes including developmental gynecomastia, congenital causes like Klinefelter syndrome, hermaphroditism, enzyme defects of testosterone production, acquired causes such as trauma, infection, torsion (twisted testicles), radiation, mumps, chemotherapy, malignancies such as bronchogenic carcinoma, alcoholism, systemic causes like congenital adrenal hyperplasia, cirrhosis, renal failure, thyrotoxicosis, and medicines.
It has been postulated that isoniazid probably acts by phenomenon called "Refeeding Gynecomastia," which is supposed to be caused by restoration of weight, gonadotrophin secretion and gonadal functions.
Awareness regarding isoniazid-induced gynecomastia would be of great help to the prescribersA 45-year-old male smoker, nonalcoholic presented with complaints of cough, expectoration, low-grade fever, and decreased appetite. Past history revealed pulmonary tuberculosis two years back and was treated with complete course of anti tuberculosis treatment. On further evaluation, he was diagnosed to have sputum positive pulmonary tuberculosis. The patient was treated with rifampicin 450 mg, isoniazid 300 mg, pyrazinamide 1500 mg, and ethambutol 800 mg, once daily. Pyrazinamide and ethambutol were stopped after the initial two months. After four months, while on isoniazid and rifampicin, the patient felt mild pain in the left mammary region, which aggravated on touching and on lying on the left side. Two weeks later, the patient noticed a swelling around the left nipple.
In this case, the chest X-Rays revealed a round lump (5 cm x 4 cm) was visible, which was tender, soft and not fixed to underlying tissues. The secondary sexual characters and the external genitalia were evaluated and found to be normal.
Isoniazid was stopped immediately with a presumptive diagnosis of isoniazid-associated gynecomastia. Antituberculous regimen except for isoniazid was given and his breast swelling and tenderness resolved slowly within 1 month. Patient completed a 9-months course of antituberculous treatment and is now on follow-up.
Male Breast Reduction surgery was performed with open excision by avulsion and excision of the lump with advanced surgical tools and mechanisms by the surgeon. The surrounding breast tissues and fat were suctioned with liposuction. The patient is on his way to recovery with a flattened chest.
Credit : http://www.articlesbase.com/cosmetics-articles/evaluation-of-a-case-of-gynecomastia-due-to-drug-reaction-6658973.html
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