Cavanaugh J, Niewoehner C B, Nuttall F Q
Section of Endocrinology, Veterans Affairs Medical Center, Minneapolis, MN 55417.
Arch Intern Med. 1990 Mar;150(3):563-5.
Hepatic cirrhosis is frequently listed as a cause of gynecomastia. We found previously that in hospitalized men the prevalence of gynecomastia was correlated with body mass index and with age. The mean body mass index and the prevalence of gynecomastia in the cirrhotic subjects (nonedematous) did not differ from those in the overall population. Because more severely cirrhotic subjects with ascites, peripheral edema, or both usually are thin, we examined 18 more severely cirrhotic subjects and 18 nonobese (mean body mass index, 20.9 +/- 0.6 kg/m2), age-matched control subjects for the prevalence of palpable gynecomastia. Total testosterone, free testosterone, total estrogen, and estradiol concentrations also were measured. Fifty percent of the control subjects had gynecomastia. Breast tissue diameter was correlated with body mass index. The prevalence of gynecomastia in the cirrhotic subjects was 44%. In these subjects no significant correlation was noted between breast tissue diameter and body mass index, presumably because the body mass index was increased owing to fluid retention. The results could not be accounted for based on medications. Serum free testosterone concentrations were lower in the cirrhotic patients than in the controls (0.11 +/- 0.02 vs 0.22 +/- 0.03 nmol/L). The total estrogen-free testosterone ratio was higher in cirrhotic patients (10.3 +/- 2.5 vs 2.6 +/- 0.5), as was the estradiol-free testosterone ratio (2.2 +/- 0.7 vs 0.5 +/- 0.1). These ratios did not differ significantly in cirrhotic subjects with and without gynecomastia. Therefore, these data indicate that factors other than the estrogen-testosterone ratio are playing a role in the development of gynecomastia in both cirrhotic subjects and controls or that breast tissue sensitivity to an elevated estrogen-testosterone ratio is highly varible.
肝硬化常被列为男性乳房发育的一个病因。我们先前发现，在住院男性中，男性乳房发育的患病率与体重指数及年龄相关。肝硬化患者（无水肿）的平均体重指数和男性乳房发育患病率与总体人群并无差异。由于有腹水、外周水肿或两者皆有的更严重肝硬化患者通常较为消瘦，我们又检查了18名病情更严重的肝硬化患者以及18名非肥胖（平均体重指数为20.9±0.6kg/m²）、年龄匹配的对照者，以了解可触及的男性乳房发育的患病率。同时还测量了总睾酮、游离睾酮、总雌激素和雌二醇的浓度。50%的对照者有男性乳房发育。乳房组织直径与体重指数相关。肝硬化患者中男性乳房发育的患病率为44%。在这些患者中，未发现乳房组织直径与体重指数之间有显著相关性，推测是因为体重指数的增加是由于液体潴留所致。这些结果无法用药物来解释。肝硬化患者的血清游离睾酮浓度低于对照组（0.11±0.02 vs 0.22±0.03nmol/L）。肝硬化患者的总雌激素与游离睾酮比值更高（10.3±2.5 vs 2.6±0.5），雌二醇与游离睾酮比值也是如此（2.2±0.7 vs 0.5±0.1）。在有和没有男性乳房发育的肝硬化患者中，这些比值并无显著差异。因此，这些数据表明，除雌激素 - 睾酮比值外，其他因素在肝硬化患者和对照者的男性乳房发育过程中也发挥着作用，或者乳房组织对升高的雌激素 - 睾酮比值的敏感性差异很大。
