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Gynecomastia

Definition:

Gynecomastia, or gynaecomastiais the development of abnormally large mammary glands in males resulting in breast enlargement, which can sometimes cause secretion of milk. The term comes from the Greek gyne (stem gynaik-) meaning “woman” and masto meaning “breast”. The condition can occur physiologically in neonates (due to female hormones from the mother; this is called witches’ milk), in adolescence, and in the elderly. In adolescent boys the condition is often a source of distress, but for the large majority of boys whose pubertal gynecomastia is not due to obesity, the breast development shrinks or disappears within a couple of years. The causes of common gynecomastia remain uncertain, although it has generally been attributed to animbalance of sex hormones or the tissue responsiveness to them; a root cause is rarely determined for individual cases.

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Breast prominence can result from hypertrophy of breast tissue, chest adipose tissue and skin, and is typically acombination. Breast prominence due solely to excessive adipose is often termed pseudogynecomastia or sometimes lipomastia.

Gynecomastia should be distinguished from work hypertrophy of the pectoralis muscles caused by much exercise, e.g. swimming,bench press.

Description of Gynecomastia

Gynecomastia is fairly common. It is a physiologic phenomenon that occurs during puberty, when at least half of males experience enlargement of one or both breasts. Pubertal hypertrophy is characterized by a tender discoid enlargement of the breast tissue beneath the areola and usually subsides spontaneously within a year.

Gynecomastia also is common among elderly men, particularly when there is associated weight gain.

This condition is usually temporary and benign. It may be caused by hormonal imbalance, medication with estrogens or steroidal compounds, or failure of the liver to inactivate circulating estrogen, as in alcoholic cirrhosis.

It tends to remit spontaneously but, if marked, may be corrected surgically for cosmetic or psychological reasons.

It can be the first sign of a serious disorder such as a testicular tumor. Medical evaluation is always indicated when breast enlargement occurs.

Less commonly, gynecomastia may be caused by a hormone-secreting tumor of the breast, lung, or other organ. Biopsy may be performed to rule out the presence of cancer.

It is more common, however, in patients with Klinefelter’s syndrome.

Pseudogynecomastia is breast enlargement due to fat accumulation.

Pseudogynecomastia can be distinguished by physical examination. The examiner places the thumb and forefinger at opposite margins of the breast. The fingers are then brought slowly together along the nipple line. Enlarged glandular tissue can be recognized as a rubbery to firm disk of tissue concentric to and beneath the areolar area. The tissue often is freely mobile and may be exquisitely tender to palpation during the acute phase of development of gynecomastia.

Causes

Physiologic gynecomastia (also called Turcios Disease) occurs in neonates, at or before puberty and with aging. Many cases of gynecomastia are idiopathic, meaning they have no clear cause. Potential pathologic causes of gynecomastia are: medications including hormones, increased serum estrogen, decreased testosterone production, androgen receptor defects, chronic kidney disease, chronic liver disease, HIV treatment, and other chronic illness. Gynecomastia as a result of spinal cord injury and refeeding after starvation has been reported. In 25% of cases, the cause of the gynecomastia is not known.

Medications cause 10-20% of cases of gynecomastia in post-adolescent adults. These include cimetidine, omeprazole, spironolactone, imatinib mesylate, finasteride and certain antipsychotics. Some act directly on the breast tissue, while others lead to increased secretion of prolactin from the pituitary by blocking the actions of dopamine (prolactin-inhibiting factor/PIF) on the lactotrope cell groups in the anterior pituitary. Androstenedione, used as a performance enhancing food supplement, can lead to breast enlargement by excess estrogen activity. Medications used in the treatment of prostate cancer such as antiandrogens and GnRH analogs can also cause gynecomastia. Marijuana use is also thought by some to be a possible cause; however, published data is contradictory.

Increased estrogen levels can also occur in certain testicular tumors, and in hyperthyroidism. Certain adrenal tumors cause elevated levels of androstenedione which is converted by the enzyme aromatase into estrone, a form of estrogen. Other tumors that secrete hCG can increase estrogen. A decrease in estrogen clearance can occur in liver disease, and this may be the mechanism of gynecomastia in liver cirrhosis. Obesity tends to increase estrogen levels.

Decreased testosterone production can occur in congenital or acquired testicular failure, for example in genetic disorders such as Klinefelter Syndrome. Diseases of the hypothalamus or pituitary can also lead to low testosterone. Abuse of anabolic androgenic steroids (AAS) has a similar effect. Mutations to androgen receptors, such as those found in Kennedy disease can also cause gynecomastia.

Although stopping these medications can lead to regression of the gynecomastia, surgery is sometimes necessary to eliminate the condition.

Repeated topical application of products containing lavender and tea tree oils among other unidentified ingredients to three prepubescent males coincided with gynecomastia; it has been theorised that this could be due to their estrogenic and antiandrogenic activity. However, other circumstances around the study are not clear, and the sample size was insignificant so serious scientific conclusions cannot be drawn.

Diagnosis

The condition usually can be diagnosed by examination by a physician. Occasionally, imaging by X-rays or ultrasound is needed to confirm the diagnosis. Blood tests are required to see if there is any underlying disease causing the gynecomastia.

Prognosis
Gynecomastia is not physically harmful, but in some cases can be an indicator of other more dangerous underlying conditions.

Growing glandular tissue, typically from some form of hormonal stimulation, is often tender or painful. Furthermore, it can frequently present social and psychological difficulties for the sufferer. Weight loss can alter the condition in cases where it is triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss. Massive weight loss can result in sagging tissues about the chest, chest ptosis.

Questions To Ask Your Doctor About Gynecomastia
*Is it gynecomastia or pseudogynecomastia?

*What is the cause?

*Is it a hormonal problem?

*Can you rule out a serious disorder such as testicular or breast cancer?

*Is it related to male hypogonadism or hyperthyroidism?

*Is the gynecomastia drug-related?

*Under what circumstances would surgical correction be indicated?

Treatment

Treating the underlying cause of the gynecomastia may lead to improvement in the condition. Patients should talk with their doctor about revising any medications that are found to be causing gynecomastia; often, an alternative medication can be found that avoids gynecomastia side-effects, while still treating the primary condition for which the original medication was found not to be suitable due to causing gynecomastia side-effects (e.g., in place of taking spironolactone the alternativeeplerenone can be used.) Selective estrogen receptor modulator medications, such as tamoxifen and clomiphene, or androgens or aromatase inhibitors such as Letrozole are medical treatment options, although they are not universally approved for the treatment of gynecomastia. Endocrinological attention may help during the first 2-3 years. After that window, however, the breast tissue tends to remain and harden, leaving surgery (either liposuction, gland excision, skin sculpture, reduction mammoplasty, or a combination of these surgical techniques) the only treatment option. Many American insurance companies deny coverage for surgery for gynecomastia treatment on the grounds that it is a cosmetic procedure. Radiation therapy is sometimes used to prevent gynecomastia in patients with prostate cancer prior to estrogen therapy. Compression garments can camouflage chest deformity and stabilize bouncing tissue bringing emotional relief to some. There are also those who choose to live with the condition

Click to see:->Gynecomastia Treatment Alternatives – What Really Works?

Herbal treatment for Gynecomastia.(1) :…(2)…..(3)

Homeopathic Medication for Gynecomastia.…….(1)….(2)

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Gynecomastia
http://www.healthscout.com/ency/68/323/main.html

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Kids are Experimenting with Steroids and HGH

Experts Fear Side Effects on Health

Doping in professional baseball has trained a spotlight on two hormones that many pro athletes use to get ahead of the competition — anabolic steroids and human growth hormone.

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But the use of those drugs isn’t limited to the professionals athletes.

They also can be found in colleges, high schools and even middle schools. And it’s not just athletes who are using them.

Young people experimenting with the hormones — using one or “stacking” two or more at a time and usually at doses much higher than would ever be medically prescribed — are just flirting with disaster, adolescent physicians and sports specialists say.

Misuse of the drugs can lead to serious consequences, including heart problems, diabetes and personality changes.

Jay Hoffman knows well some of those side effects:
Now a professor of health and exercise science at the College of New Jersey, Hoffman used anabolic steroids in NFL training camps with the Philadelphia Eagles and the New York Jets in the 1980s, a time when their use was legal.

He encountered what he called the “normal side effects”– hypertension, acne, fluid retention — but stopped using the drugs when he became overly aggressive after taking Anadrol, an oral steroid notorious for its potency.

“I decided that it just didn’t pay for me, every year to struggle to make a club and to use that,” said Hoffman, who now helps advise baseball’s Texas Rangers and other teams about steroid use. “I just didn’t like what was going on.”

Hoffman and others believe that pro athletes, such as Roger Clemens, have a responsibility as role models to younger athletes in terms of proper training techniques.
Clemens was the biggest name in a report headed by former Senate majority leader George Mitchell on the use of steroids and other performance-enhancement drugs in baseball. The FBI is investigating Clemens to determine whether he lied to a congressional panel when he denied taking steroids and HGH.

Anabolic steroids, also called anabolic-androgenic steroids, are synthetic versions of testosterone, a hormone that occurs naturally in the body. We need testosterone, which is produced the adrenal gland or testicles, and human growth hormone at different times to grow and develop normally. Anabolic means to “build up,” and androgenic refers to the development and maintenance of male sexual characteristics, such as deeper voice, body hair and muscle mass.

Young people feel the pressure:
Dr. Joe Congeni, sports medicine director at Akron Children’s Hospital, estimates that between 8 percent and 10 percent of high school athletes in our region use anabolic steroids, a number that has not changed much recently.

“I think there’s a lot of pressure on these kids to experiment,” said Congeni. “They don’t care about the future; they care about the now. That’s a natural trait of teenagers.”

A child who takes anabolic steroids before he or she is done growing faces a potentially irreversible side effect: closure of the growth plates, which are areas of cartilage that allow the bones to grow through adolescence. One progressive course of steroids is enough to permanently close the growth plates and stunt growth, according to Dr. Bernard Griesemer, a St. Louis expert on steroid use in young athletes.

HGH is produced by the pea-sized pituitary gland located at the base of the brain. HGH stimulates growth and cell production, causing increased height in childhood and maintenance of muscle and tissue throughout life.

HGH is often lumped together with steroids as a performance enhancer. While several studies have found that it reduces body fat and increases muscle mass, there is little evidence it increases strength or stamina.

Many athletes use HGH, to sculpt the muscles, in combination with anabolic steroids, which add strength. HGH also has become popular with nonathletes and recently has been tied to musicians, rappers and other celebrities.

And when celebrities are using it, the kids who want to look like them will usually try it too, said Griesemer.

“It’s becoming more common, because it’s now no longer just for the athlete population, it’s for the kids who want to look like they’ve just walked off the magazine cover,” said Griesemer, who was an anti-doping investigator for the 1998 Winter Olympics. “They’re using [HGH] for cosmetic purposes only.”

HGH is not addictive, but it can cause high cholesterol and problems with cardiovascular health and may increase the risk for diabetes, said Leona Cuttler, chief of pediatric endocrinology at Rainbow Babies & Children’s Hospital. Because HGH triggers an increase in cell production and growth, many doctors worry there is an increased cancer risk with its use.

The fight to control HGH
HGH is not a controlled substance like anabolic steroids. The federal government regulates the manufacture, distribution and use of drugs classified as controlled substances.

But many feel it is much too easy for people, including teenagers, to get their hands on HGH, and in December, Sen. Charles Schumer, a New York Democrat, and Sen. Charles Grassley, an Iowa Republican, introduced legislation that would make HGH a controlled substance.

That move has frustrated endocrinologists who treat patients, primarily children, with a legitimate medical need for the hormone. Cuttler, who also is director of the Center for Child Health and Policy at UH, calls it a misguided effort that has “sort of lumped growth hormone and steroids as drugs that are abused by athletes without sorting out their medical needs.

“I think there is a momentum to do something and to avoid it being used by athletes, and avoid it being in the culture of young people and adolescents,” she said. “But I’m just not sure this is the right way to approach it.”

Griesemer disagrees.
“I don’t see the logic of their lack of support,” he said. “This stuff is not coming in by the package. It’s not coming in by the truckload. It’s coming into this country by the container-load. It’s a mess.”

Hoffman is concerned about teens using these black-market hormones without supervision simply because they see their idols doing it and think it must be safe.

“If you spend five minutes in a locker room, you realize these guys should not be role models,” he said. “I don’t think there’s enough research out there, and you’re running the risk of some serious, irreversible side effects.”

WHEN PEOPLE NEED TO TAKE STEROIDS:
People often are confused about steroid abuse because there are several different kinds of steroid hormones that serve different purposes in the body. All are lipid soluble, meaning they dissolve in fats. They pass easily through the cell membrane and bind to a specific receptor in the cell.

Glucocorticoids: A type of steroid that includes prednisone, dexamethasone and hydrocortisone. Often prescribed to treat inflammatory conditions, such arthritis, pneumonia and asthma, or to prevent organ rejection. “This is often what people mean when they say their grandmother took steroids,” said Dr. Thomas Murphy, director of the Division of Endocrinology at MetroHealth Medical Center.

Anabolic-androgenic steroids: Includes testosterone and its synthetic equivalents. Used to replace testosterone in people with a deficiency. Any disease or damage to the testicles, pituitary gland or hypothalamus, as well as genetic abnormalities, chemotherapy, tumors, infection and glandular malformations can cause such a deficiency.

There is little data on the long-term consequences of anabolic steroid use or about what happens when they are used in very high levels, as is often reported by athletes and bodybuilders. At medical doses, common but reversible side effects include hair loss, acne, development of breast tissue in males, infertility and decreased testicular size, said Murphy.

More serious recognized side effects include hypertension and a small but significant effect on cholesterol levels that can increase chances of a heart attack or a stroke.

A child who takes a course of these steroids before he or she is done growing could permanently close the bone’s growth plates, irreversibly stunting growth.Lack of proof: Dr. Bernard Griesemer, an expert on steroid use in teens, often is frustrated by the argument that none of the side effects of steroid use has been proven.

“When people [use that argument] you have to point out that they’re never going to be able to prove this,” he said. “You’re not going to take a child and put him in a double-blind crossover study using a potentially lethal medication.

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Sources:http://blog.cleveland.com/lifestyles/2008/03/kids_are_experimenting_with_st.html

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