big breasts
Introduction
Introduction 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.
Cause
Cause
First, the cause classification and pathogenesis
More complicated, the pathogenesis may have the following factors:
(1) Relative or absolute increase in estrogen
Testosterone can be converted into estrogen in the body. For particularly sensitive breast tissue, testosterone itself can also cause hyperplasia.
(B) increased pituitary gonadotropin
In particular, the luteinizing hormone, prolactin, can cause connective tissue between the ducts of the breast and increase the adipose tissue.
(3) The sensitivity of breast tissue to normal trace estrogen in male body fluids is enhanced.
(4) The application of estrogen or estrogen-like drugs such as reserpine, isoniazid, and chorionic gonadotropin.
Examine
an examination
Related inspection
Estrogen breast examination breast ultrasound examination
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 of oral mucosal chromatin and chromosome, karyotype and other examinations.
(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 breast 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 shape of the glandular distribution of glands can be clear
(2) MRI examination of the saddle area can be taken when the MRI examination of the saddle area is suspected to be hypothalamic-pituitary disease or tumor.
(3) CT examination of the adrenal gland and B-ultrasound of the abdominal organs are suspected adrenal diseases or tumors, and it is feasible to check the CT of the adrenal gland and the B-ultrasound of the abdominal organs.
(4) B-ultrasound examination of thyroid or testis suspected of thyroid, testicular dysfunction, thyroid or testicular B-ultrasound.
Diagnosis
Differential diagnosis
(1) Physiological gynecomastia
1. Newborn breasts are large, disappearing after a week or so, and a few can last for several years, which is the estrogen effect in the blood circulation and placenta.
2. Young boys develop different degrees of mammary gland development, or about 70% of boys. This may be due to increased sensitivity of breast tissue. It lasts for several years and gradually disappears on its own. It can also disappear for a lifetime, called idiopathic breast development.
3. After middle age, when men begin to have sexual dysfunction, they often have sexual breast development, which may cause imbalance of sex hormones due to increased secretion of pituitary gonadotropin.
(two) pathological male breast development
1. Testicular tumors: such as chorionic epithelial cancer, stromal cell tumor.
2. Adrenal cortical tumors with feminization: often malignant, occur in adolescence or adults, in addition to breast development, accompanied by testicular atrophy, penis shrinkage, sexual dysfunction. Urinary ketosteroids and estrogen emissions increased.
3. Hypothyroidism: may be accompanied by increased thyroid stimulating hormone, gonadotropin and other pituitary hormones.
4. Gonadal dysplasia: such as male pseudohermaphroditism, testicular dysplasia, accompanied by increased pituitary gonadotropin.
5. Impaired liver function such as cirrhosis, liver cancer and hepatitis: Estrogen levels may be increased due to weakening of estrogen inactivation in the body.
6. Malnutrition recovery period: due to long-term malnutrition, or chronic wasting disease, gonads and pituitary functions sensitive to protein deficiency. Once nutrition is improved, physical strength gradually recovers, pituitary gonadotropin secretion function reactivates, so-called second puberty The gonad function is reactivated, but the long-term impaired liver function cannot be restored at the corresponding rate, resulting in endocrine disorders. The mechanism seems to be equivalent to the combined presence of cirrhosis and idiopathic breast development. These patients are often accompanied by hepatomegaly or liver dysfunction.
7. Drugs: such as reserpine, isoniazid, etc., whether it has similar estrogen-like effects, there are differences of opinion. The application of chorionic gonadotropin also allows the mammary gland to develop.
8. Others: such as certain autoimmune diseases, paraplegia caused by spinal cord injury, and bronchial cancer, tuberculosis or bronchiectasis, especially breast cancer. Pay attention to the history of taking medicine. Pay attention to the signs of thyroid, testicular and intra-abdominal mass during physical examination. Liver function, urinary steroids, urinary estrogen and gonadotropin levels were measured. Oral mucosal chromatin examination, adrenal CT scan, saddle X-ray, examination of endocrine gland tumors.
