male puberty breast development
Introduction
Introduction to male adolescent breast development Male adolescent breast development (maleadolescentmammoplasia) refers to the enlargement of one or both breasts caused by benign hyperplasia of mammary gland in male development. When the diameter of male breast tissue is more than 0.5cm in childhood and adolescence, it can be found by clinical examination. Male breast development is a very common clinical phenomenon, which can be seen in neonatal, adolescent and adulthood. Here we mainly introduce male adolescent breast development. basic knowledge The proportion of the disease: 0.6% (the above is the probability of childhood, adolescent male disease) Susceptible people: male Mode of infection: non-infectious Complications: psychological disorders
Cause
Male adolescent breast development etiology
(1) Causes of the disease
The etiology of male breast development can be divided into two categories: physiological and pathological:
1. Physiological male breast development (physiological gynecomastia)
After entering puberty, male sexual organs develop rapidly and develop gradually according to the male sexual development program. During this period, with the rapid development of testis and epididymis, the serum level of male sex hormone testosterone changes significantly, and testosterone levels increase in Tanner II stage. Not obvious, but the growth of Tanner III period suddenly accelerated, while the serum E2 level also increased in the Tanner III period, and the serum prolactin PRL level decreased slightly in the Tanner II stage of puberty, but increased rapidly as soon as entering the Tanner III stage. To the peak of puberty development Tanner IV, followed by decreased PRL levels, breast development in adolescent boys may be associated with increased testosterone secretion accompanied by a slight increase in estrogen E2 prolactin PRL, in addition, known as male familial breast hypertrophy (familial gynecomastia) means that individual boys develop breast enlargement when they enter puberty, and the enlarged breasts are not easy to retract, but they are benign.
2. Pathological male breast development
(1) Tumor: Testicular tumor and feminine adrenal cortical tumor, the patient may be accompanied by male breast development, which is caused by the excessive production of estrogen in the tumor tissue and the aromatization of surrounding tissues.
(2) hypogonadism and androgen insensitivity syndrome: due to congenital dysplasia or testosterone biosynthetic enzyme deficiency and due to infection, chemotherapy, trauma leading to testicular dysfunction, mostly associated with male breast development, due to reduced testosterone concentration, through negative feedback Mechanism serum LH increased, while stimulating stromal cell aromatase activity increased, estradiol secretion increased, the latter further inhibited testicular cytochrome oxidase P-450 and C17-mediated 17,20 lyase and 17-alpha hydroxy The activity of the enzyme ultimately reduces the synthesis of testosterone, resulting in an imbalance between estrogen and androgen concentrations.
(3) Extra-gonadal tissue aromatization of estrogen precursors: can be seen in a variety of diseases such as obesity, liver disease, hyperthyroidism, congenital adrenal hyperplasia, Klinefilter syndrome.
(4) drugs: Many drugs can also cause male breast development, such as androgen, synthetic steroid hormones, estrogen, chorionic gonadotropin, ketoconazole, digitalis, drugs that inhibit testosterone synthesis.
(two) pathogenesis
Early onset of male breast development (first 6 months) is characterized by hyperplasia of the mammary gland, epithelial cell hyperplasia, connective tissue around the mammary duct and vascular hyperplasia and perivascular edema, called active phase, and the epithelial cells recover after 12 months. At rest, the catheter is dilated, and the matrix is hyaline and fibrotic.
Adolescent male breast development is mainly caused by the relative imbalance of androgen and estrogen levels, absolute or relative increase in estrogen levels, decreased free androgen synthesis, decreased circulating concentrations and decreased activity can cause males Breast development, or because of the increased sensitivity of breast tissue to normal levels of estrogen, studies have found that the concentration of estradiol in the early adolescence can be transiently elevated, which may enhance the activity of aromatase in the body, so that The conversion of adrenal androgens (mainly androstenedione) to estrogen increases, causing adolescent males to reach adult levels before serum testosterone levels peak, resulting in an abnormal ratio of androgen/estrogen , adolescent male breast development.
Prevention
Male adolescent breast development prevention
Actively remove the cause, if it is caused by drugs, stop using or switch to other drugs;
If it is caused by liver disease, it can be treated with liver protection;
Endocrine diseases should be treated due to endocrine disorders;
If the tumor is caused, the tumor can be surgically removed;
If the nutrition is lacking, it will be supplemented with nutrition.
Complication
Male adolescent breast developmental complications Complications
The disease is clinically benign, with no complications, but a few can cause psychological disorders.
Symptom
Male adolescent breast development symptoms Common symptoms Liver palm and abdomen masses spider mites
1. Ask about medical history
Detailed medical history should be asked, including family history, personal nutrition history, growth and development history, time when the breast begins to develop, medication history, such as synthetic steroid hormones, chorionic gonadotropin and amphetamine.
2. Physical examination
Care must be taken to distinguish between male breast development and pseudo-female breasts. The latter is an increase in breast adipose tissue rather than an increase in breast glandular composition. During the examination, attention is paid to the presence or absence of a breast mass. During the examination, the patient takes the supine position and puts both hands on the head. After that, the examiner puts the thumb and forefinger at the bottom of the breast, and then slowly closes, the increase in breast adipose tissue, no resistance during the slow closing of the thumb and forefinger, while the male breast development, the hand from the bottom of the breast to the nipple When closed, it can touch the concentric shape, the texture is tough, and the rubbery tissue. During the examination, the patient may have a tender feeling and pay attention to whether there is a breast mass.
Physical examination should pay special attention to the development of secondary sexual characteristics in adolescence, carefully check the size of the testicles and whether there are lumps, whether there are feminine signs and spider mites, liver palms, abdominal masses and so on.
3. Distinguish between physiological or pathological breast development
It is found that male adolescent breast development should first distinguish between physiological or pathological breast development. The main application is exclusion. Male sexual organs include testis, epididymis, seminal vesicle, vas deferens, prostate, penis, scrotum. Under normal circumstances, before puberty, That is, in the first 9 to 10 years after birth, the male sexual organs develop very slowly. Once they enter the late puberty, the development is accelerated, and gradually matures according to the male sexual development program. The boy will have breast enlargement and enlargement when entering the puberty stage. The breast is not easy to retract, but it is benign, this is a physiological breast enlargement, most people can naturally relieve within 12 to 18 months, generally should be reviewed every 6 months.
However, to determine the physiological breast enlargement first need to rule out the various causes of pathological breast enlargement, through detailed medical history and physical examination, combined with laboratory and auxiliary examination, to rule out various causes, such as: 1 testicular tumor and feminized adrenal cortex Tumor; 2 due to congenital dysplasia or testosterone biosynthetic enzyme deficiency and due to infection, chemotherapy, trauma leading to testicular dysfunction; 3 obesity, liver disease, hyperthyroidism, congenital adrenal hyperplasia, Klinefilter syndrome, etc.; 4 drugs cause male breasts Development and so on.
Examine
Male adolescent breast development check
Breast development in adolescent boys may be associated with increased testosterone secretion accompanied by a slight increase in estrogen E2 prolactin PRL.
Testosterone
Testosterone levels were not significantly elevated in the Tanner stage II, but accelerated to the Tanner stage III, and serum E2 levels also increased in the Tanner stage.
2. Prolactin PRL
Serum prolactin PRL levels were slightly reduced in the Tanner II phase of puberty, but increased rapidly as soon as entering the Tanner III phase, reaching a peak in the Tanner IV phase of puberty, followed by a decrease in PRL levels.
Abdominal B-ultrasound should be done to understand the liver, spleen and testicular tumors; to do breast ultrasound and infrared scanning, except for breast cancer and other diseases.
Diagnosis
Diagnosis and diagnosis of male adolescent breast development
diagnosis
According to the clinical characteristics, it is necessary to exclude breast tumors, sex chromosome abnormalities and other diseases, and the necessary examination can confirm the diagnosis. First, the medical history and detailed physical examination should be carefully inspected, and attention should be paid to the presence or absence of breast masses. In particular, attention should be paid to the development of secondary sexual characteristics during adolescence. Carefully check the size of the testicles and whether there are lumps, whether there are feminine signs and spider mites, liver palms, abdominal masses, etc.
If necessary, do a variety of hormone determination and biochemical tests, including liver function, thyroid hormone, LH, FSH, testosterone and estradiol, androstenedione, especially 24h urine specimens to determine the ratio of estradiol / testosterone increased Reliable, if necessary, testicular ultrasound and adrenal CT or MRI should be performed to exclude tumors of the testes, adrenal glands and other tissues.
Differential diagnosis
Adolescent male breast development according to clinical male breast enlargement, diagnosis is not difficult, but if the unilateral breast enlargement, it needs to be differentiated from breast tumors, breast ultrasound or infrared scanning can help identify, if necessary, plasma androgen can be measured And estrogen levels and plasma alpha-fetoprotein, human carcinoembryonic antigen, etc. to identify, mainly differentiated from androgen insensitivity syndrome.
