What are the causes of gynaecomastia?

Gynaecomastia

If is found in the following conditions: 


Physiological: gynaecomastia typically occurs at 3 distinct periods of life
  • Neonatal: due to crossing of maternal and placental estrogens into newborn’s circulation
  • Puberty:  (in whom estradiol concentrations reach adult levels before testosterone
  • Adult life: Type occurs in 50-80 years of age due to decreasing testosterone concentrations


Drug-induced
  • Spironolactone
  • Cimetidine
  • Digoxin
  • Finasteride
  • Anti-androgens (cyproterone acetate, spironolactone)
  • Some exogenous anabolic steroids (diethylstilbestrol)
  • Cannabis

Hypogonadism
Androgen resistance syndromes
Oestrogen excess
  • Liver failure (impaired steroid metabolism)
  • Oestrogen-secreting tumour (e.g. of testis)
  • Human chorionic gonadotrophin-secreting tumour (e.g. of testis or lung)

Syndromes with androgen deficiency: Kallman's, Klinefelter's
Testicular failure: e.g. mumps
Testicular cancer:  e.g. seminoma (secreting hCG), teratoma


Source:
  • Davidsons Principles and Practice of Medicine 23th edition; 657
  • Kumar & Clark’s Clinical Medicine 9th edition: 1218


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