Gynecomastia
Introduction
Introduction to male breast hypertrophy Male breast hypertrophy, also known as men's and women's breasts, refers to unilateral or bilateral breast hypertrophy that occurs in men at different times and at different ages, may have breast tenderness, and can be touched under the areola. Individually visible nipple retraction nipple discharge, some of the shape is similar to the adolescent girl's breast, so the clinical also known as adolescent breast hypertrophy, middle-aged breast hypertrophy, idiopathic male breast hypertrophy. basic knowledge The proportion of illness: 0.05%, more common in obese people Susceptible population: male, more common in middle age or old age, can also occur in adolescence, obese are more common Mode of infection: non-infectious Complications: Hypertension Hyperlipids
Cause
Causes of male breast hypertrophy
Endocrine physiological disorders (30%):
More common in children, adolescence, often due to endocrine physiological disorders, plasma estradiol content is higher than testosterone, resulting in a transient ratio of estrogen and androgen, or increased sensitivity of breast tissue to estrogen, also known as Physiological male breast hypertrophy.
Abnormal secretion of sex hormones (30%):
Organ diseases that regulate the secretion of sex hormones cause abnormal secretion of sex hormones, and the common ones are:
(1) testicular disease due to hypogonadism, androgen secretion is very low, blood testosterone, estrogen ratio changes, causing men's breast hypertrophy 1 congenital testicular hypoplasia (Klinefelter syndrome); 2 complete testicular feminization; 3Kallmann Syndrome; 4 testicular inflammation, trauma and tumor; 5 Reifenstein syndrome.
(2) adrenal diseases such as adrenal hyperplasia, benign tumors, malignant tumors and dysfunction, which can directly secrete estrogen or produce excessive estrogen precursors (such as androstenone), which are converted into effective in tissues. The estrogen, elevated blood estradiol, causes breast hypertrophy.
(3) Thyroid diseases such as hyperthyroidism, increased concentrations of plasma serotonin-binding globulin, excessive levels of androgen combined, elevated estradiol (unbound estradiol), and estrogen/testosterone ratio High hormonal imbalance causes stimulation of breast tissue hyperplasia, leading to male breast hypertrophy.
Other factors (15%):
(1) Liver diseases such as hepatitis, cirrhosis, liver cancer, etc., accompanied by liver dysfunction, often cause breast hypertrophy.
(2) Reduced gonadotropin secretion during malnutrition during chronic malnutrition recovery. When malnutrition is corrected, a side-effect second puberty phenomenon occurs, and the appearance of breast hypertrophy is called "feeding increased breast hypertrophy."
(3) Bronchial lung cancer and chronic lung diseases such as oat-like cell carcinoma, tuberculosis, empyema, etc., may cause breast hypertrophy due to local irritation.
(4) Chronic renal failure Chronic renal failure caused by uremia patients, the test found that the blood estrogen is relatively elevated, prolactin concentration also increased, leading to breast development, hypertrophy.
(5) Neurological diseases such as paraplegia caused by high spinal cord disease, syringomyelia, hereditary movement disorders, may be associated with hypertrophy of the breast.
(6) Prostatic hyperplasia or prostate cancer patients often take estrogen for treatment, often cause male breast hypertrophy.
(7) lymphatic system disease lymphoma, malignant histiocytoma myeloma and other reticuloendothelial diseases, etc., also rare male breast development.
(8) drug-induced breast hypertrophy gonadotropin chlorpromazine, cimetidine (cimetidine), methyldopa, metoclopramide (gasprep), metronidazole (metidazole) Haze, Lisheping (Li Xueping) sleep and pass, thyroid extract, etc., can bind to estrogen receptors, causing secretion dysfunction in the body, can cause male breast development, but increased breasts after stopping the drug restore.
(9) Other diseases such as cardiovascular disease (hypertension, heart disease), severe skin disease (leprosy, exfoliative dermatitis), autoimmunity, etc.
Prevention
Male breast hypertrophy prevention
The disease is more common in middle age or old age, and can also occur in adolescence.
1. Use drugs that may disrupt endocrine with caution.
2, avoid fatty, avoid cold and irritating food.
3, diet rich in nutritious and easy to digest food.
4. Strengthen physical exercise, control sexual intercourse, and avoid overwork.
5, self-cultivation, keep your mood comfortable.
6, active treatment of various primary diseases.
7, generally do not need treatment, symptoms are obvious, you can remove hypertrophic breast tissue, should retain the nipple and skin.
Complication
Male breast hypertrophy complications Complications, hypertension, hyperlipidemia
The disease is usually associated with obesity, so it is often associated with hyperlipidemia and hypertension in the clinic. At the same time, the disease can cause breast cancer due to the progressive growth of the gland, so the clinical breast hypertrophy can not be ignored, if necessary, surgical treatment should be carried out to eliminate the cause of cancer.
Symptom
Male breast hypertrophy symptoms Common symptoms Male breast large breast hypertrophy High blood lipid vascular damage
Male unilateral or bilateral mammary gland is female development, hypertrophy and hypertrophy, nipple and areola development are good, under the areola can touch the disk, the texture is hard and tough, the clear diffuse mass is more than 2 ~ 3cm, there is a certain activity Sex and skin are non-adhesive. A small number of patients have pain or mild tenderness, and very few may have nipple discharge.
Clinical classification is divided into three types according to the hyperplasia and hypertrophy of the breast site and size.
Diffuse type
Hyperplastic mammary gland is diffuse, often in the form of a disk under the areola, does not form isolated nodules, accompanied by mild pain and tenderness is characterized by a medium volume.
2. Adenoma type
The mass is isolated nodules, with good activity and no adhesion, clear surrounding and small volume. This type should be differentiated from male breast cancer.
3. Female type
The bilateral mammary glands are well-proportioned hypertrophy without obvious nodules. The nipple can have a white milk-like nipple discharge with a large volume, and the appearance is similar to that of adolescent girls.
Examine
Male breast hypertrophy check
Laboratory examination
(1) Thyroid function test: blood T3, T4, TSH.
(2) Adrenal function test: ACTH, blood cortisol.
(3) liver and kidney function tests.
(4) Gonadal function tests: E2, T, PRL, LH, FSH and -HCG.
(5) Genetic examination: examination of oral mucosal chromatin and chromosome and karyotype.
(6) Histopathological examination: When the above examination can not confirm the diagnosis of primary lesions, it is feasible to take a fine needle aspiration biopsy or biopsy.
2. Auxiliary inspection
(1) X-ray examination of mammography: The shape of the mammary gland is normal. In addition to normal fatty fibrous tissue, hyperplastic glands are seen. After the areola area, the flakes, fan-like or disc-like dense shadows have a uniform density. Most of the gland edges are blurred, and the brush is visible to the surroundings. The margin of the glandular distribution of the glands can be clear.
(2) MRI examination in the saddle area: MRI examination of the saddle area can be taken when the hypothalamic-pituitary disease or tumor is suspected.
(3) CT examination of the adrenal gland and B-ultrasound of the abdominal organs: suspected adrenal diseases or tumors, feasible CT examination of the adrenal gland and B-ultrasound of the abdominal organs.
(4) B-ultrasound examination of thyroid or testis: suspected thyroid, testicular dysfunction, thyroid or testicular B-ultrasound.
Diagnosis
Diagnosis and diagnosis of male breast hypertrophy
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
It should be differentiated from male breast cancer, which is hard and infiltrates into surrounding tissues with limited mobility.
The earliest manifestation of breast cancer is that the milk has a single, painless and progressive small mass. The mass is most common in the outer upper quadrant, followed by the nipple, the areola area and the upper upper quadrant. Often found by patients inadvertently (such as bathing, changing clothes), a small number of patients may have varying degrees of tenderness or irritation and nipple discharge, the growth of the mass is faster, invasion of surrounding tissue can cause changes in breast shape, appear A series of signs, such as: tumor surface skin depression adjacent to the nipple cancer can lead the nipple to the direction of the cancer nipple retraction, etc., the larger the cancer, the whole breast tissue can shrink, the mass is prominent, the cancer continues to grow The formation of so-called "orange peel" changes, these are important signs of breast cancer.
Breast cancer develops to the advanced stage, the surface skin is invaded, skin induration can occur, and even the skin ulcerates and forms ulcers. The cancer invades into the deep layer and can invade the chest fascia and the chest muscles, causing the mass to be fixed on the chest wall and not easy to push.
