Eristavi S Kh, Rozhivanov R V, Nikankina L V, Kolesnikova G S, Rozhivanova E R, Andreeva E N, Mel'nichenko G A, Mokrysheva N G
Endocrinology Research Centre.
Endocrinology Research Centre; Russian University of Medicine.
Probl Endokrinol (Mosk). 2024 Sep 16;70(4):114-120. doi: 10.14341/probl13491.
In recent years, the incidence of gynecomastia in adult men has increased significantly. It is of interest to study the specific features of the disease in these patients.
To identify the main characteristics of acute gynecomastia in adult men.
A continuous one-stage study including 160 adult males with acute onset gynecomastia, who were he was treated in Endocrinology Research Centre, Moscow. Total bilirubin, hepatic transaminases, creatinine, urea, luteinizing hormone, prolactin, sex hormone binding globulin, estradiol, total testosterone, alpha-fetoprotein, chorionic gonadotropin and mammary gland condition were evaluated in all patients. Baseline significance threshold level of p<0.05.
The incidence of gynecomastia increased from 5,4% in 2020 to 14,4% in 2024. Tumor forms of gynecomastia were rare, with 1,2% (95% CI 0,0; 3,0) of cases. In 30% (95% CI 22,9; 37,1) of men, gynecomastia was due to the intake of anabolic steroids for athletic stimulation. In 11,2% (95% CI 6,4; 16,1) of patients, gynecomastia was hepatogenic. In 7,5% (95% CI 3,4; 11,6), it was due to elevated sex hormone binding globulin. 47,5% (95% CI 39,8; 55,2) were endocrine non-tumorigenic form of gynecomastia due to excess body weight with formation of changes in sex hormone levels. The patients who took anabolic steroids were characterized by young age, as well as decreased luteinizing hormone levels and increased testosterone levels. The group of patients with elevated sex hormone binding globulin had no clinically significant features. Men from the group of hepatogenic gynecomastia were characterized by hyperestrogenism. Patients in the group with altered sex hormone levels were characterized by high body mass index and either increased estradiol or decreased testosterone or a combination of both.
The number of adult male patients with acute gynecomastia is progressively increasing. In the examined sample of patients, the main causes of gynecomastia were patients taking anabolic steroids, liver dysfunction and weight gain with the formation of changes in sex hormone levels. Patients taking anabolic steroids were characterized by a drug--induced increase in testosterone and estradiol levels, which was accompanied by suppression of pituitary gonadotropic function. Estradiol elevation was also characteristic of patients with hepatogenic form of gynecomastia and men with excess body weight with formation of changes in sex hormone levels.
近年来，成年男性乳腺增生症的发病率显著上升。研究这些患者疾病的具体特征很有意义。
确定成年男性急性乳腺增生症的主要特征。
一项连续性单阶段研究，纳入了160例急性起病的成年男性乳腺增生症患者，他们在莫斯科内分泌研究中心接受治疗。对所有患者评估了总胆红素、肝转氨酶、肌酐、尿素、促黄体生成素、催乳素、性激素结合球蛋白、雌二醇、总睾酮、甲胎蛋白、绒毛膜促性腺激素和乳腺状况。基线显著性阈值水平为p<0.05。
乳腺增生症的发病率从2020年的5.4%上升至2024年的14.4%。乳腺增生症的肿瘤形式罕见，占病例的1.2%（95%置信区间0.0；3.0）。在30%（95%置信区间22.9；37.1）的男性中，乳腺增生症是由于为增强运动能力而摄入合成代谢类固醇所致。在11.2%（95%置信区间6.4；16.1）的患者中，乳腺增生症是由肝脏疾病引起的。在7.5%（95%置信区间3.4；11.6）的患者中，是由于性激素结合球蛋白升高所致。47.5%（95%置信区间39.8；55.2）是由于体重超标导致性激素水平变化而形成的内分泌非肿瘤性乳腺增生症形式。服用合成代谢类固醇的患者以年轻为特征，同时促黄体生成素水平降低和睾酮水平升高。性激素结合球蛋白升高组的患者没有临床显著特征。肝脏疾病引起的乳腺增生症组的男性以雌激素过多为特征。性激素水平改变组的患者以高体重指数为特征，且雌二醇升高或睾酮降低或两者兼有。
成年男性急性乳腺增生症患者数量在逐渐增加。在所检查的患者样本中，乳腺增生症的主要原因是服用合成代谢类固醇、肝功能障碍以及体重增加导致性激素水平变化。服用合成代谢类固醇的患者其特征是药物诱导睾酮和雌二醇水平升高，同时伴有垂体促性腺功能受抑制。雌二醇升高也是肝脏疾病引起的乳腺增生症患者以及体重超标导致性激素水平变化的男性的特征。
