Pubertal gynecomastia: years of progress – the Hacettepe experience
-
Sinem Akgül
Abstract
Gynecomastia is defined as an enlargement of the male breast. Although it is commonly seen during puberty, it is often overlooked by many physicians. As adolescent medicine specialists, we believe there is a gap in the literature concerning both the etiology and maybe more importantly the care of these adolescents. Thus, we have been dedicated to conducting research on this topic. The aim of this review article was to evaluate the studies concerning pubertal gynecomastia that took place at the Division of Adolescent Medicine, Hacettepe University, published between the years 2003 and 2016. The review covers in detail both the short- and long-term effectivity and safety of tamoxifen used for the treatment of pubertal gynecomastia. As the exact basis for the pathogenesis of gynecomastia remains unknown, we also evaluate three studies that aimed to answer this question. We additionally review a study that aimed to assess the psychological distress and effect on body image that gynecomastia may have on the adolescent male. An important contribution this review article adds to the literature is as a conclusion to all the studies performed, we present the ‘Hacettepe indications for tamoxifen treatment for pubertal gynecomastia’. These indications will aid physicians when considering treating these patients.
Acknowledgment
We would especially like to thank our mentor Prof. Dr. Erol Kınık who was the first physician to start using tamoxifen for pubertal gynecomastia at the Division of Adolescent Medicine, Hacettepe University.
Conflict of interest statement: The authors declare that they have no conflict of interest.
[1] Akgül S, Kanbur N, Derman O. A different training model for adolescent medicine: a PhD program in Turkey, where adolescent medicine is not currently a sub-specialty at this stage. Int J Adolesc Med Health. 2016;28(3):269–72.10.1515/ijamh-2016-5008Search in Google Scholar PubMed
[2] Carlson HE. Gynecomastia. N Engl J Med. 1980;303(14):795–9.10.1056/NEJM198010023031405Search in Google Scholar PubMed
[3] Braunstein GD. Gynecomastia. N Engl J Med. 2007;357(12):1229–37.10.1056/NEJMcp070677Search in Google Scholar PubMed
[4] Boljanovic S, Axelsson C, Elberg J. Surgical treatment of gynecomastia: liposuction combined with subcutaneous mastectomy. Scand J Surg. 2003;92(2):160–2.10.1177/145749690309200209Search in Google Scholar PubMed
[5] Lawrence SE, Arnold Faught K, Vethamuthu J, Lawson ML. Beneficial effects of raloxifene and tamoxifen in the treatment of pubertal gynecomastia. J Pediatr. 2004;145(1):71–6.10.1016/j.jpeds.2004.03.057Search in Google Scholar PubMed
[6] Riepe FG, Baus I, Wiest S, Krone N, Sippell WG, Partsch C-J. Treatment of pubertal gynecomastia with the specific aromatase inhibitor anastrozole. Horm Res. 2004;62(3):113–8.10.1159/000079882Search in Google Scholar PubMed
[7] Lapid O, van Wingerden JJ, Perlemuter L. Tamoxifen therapy for the management of pubertal gynecomastia: a systematic review. J Pediatr Endocrinol Metab. 2013;26(9-10):803–7.10.1515/jpem-2013-0052Search in Google Scholar PubMed
[8] Wood AJ, Osborne CK. Tamoxifen in the treatment of breast cancer. N Engl J Med. 1998;339(22):1609–18.10.1056/NEJM199811263392207Search in Google Scholar PubMed
[9] Derman O, Kanbur NÖ, Kutluk T. Tamoxifen treatment for pubertal gynecomastia. Int J Adolesc Med Health. 2003;15(4):359–64.10.1515/IJAMH.2003.15.4.359Search in Google Scholar PubMed
[10] Derman O, Kanbur N, Kınıç I, Kutluk T. Long-term follow-up of tamoxifen treatment in adolescents with gynecomastia. J Pediatr Endocrinol Metab. 2008;21(5):449–54.10.1515/JPEM.2008.21.5.449Search in Google Scholar PubMed
[11] Derman O, Kanbur N, Tokur TE. The effect of tamoxifen on sex hormone binding globulin in adolescents with pubertal gynecomastia. J Pediatr Endocrinol Metab. 2004;17:1115–20.10.1515/JPEM.2004.17.8.1115Search in Google Scholar PubMed
[12] Kilic M, Kanbur N, Derman O, Akgül S, Kutluk T. The relationship between pubertal gynecomastia, prostate specific antigen, free androgen index, SHBG and sex steroids. J Pediatr Endocrinol Metab. 2011;24(1-2):61–7.10.1515/jpem.2011.112Search in Google Scholar PubMed
[13] Durmaz E, Özmert EN, Erkekoğlu P, Giray B, Derman O, Hıncal F, et al. Plasma phthalate levels in pubertal gynecomastia. Pediatrics. 2010;125(1):e122–9.10.1542/peds.2009-0724Search in Google Scholar PubMed
[14] Pehlivantürk Kızılkan M, Akgül S, Akbıyık F, Derman O, Kanbur N. Evaluation of serum vitamin D levels in adolescents with pubertal gynecomastia. Breast Care. 2016;11:333–7.10.1159/000451074Search in Google Scholar PubMed PubMed Central
[15] Akgül S, Kanbur N, Güçer Ş, Şafak T, Derman O. The histopathological effects of tamoxifen in the treatment of pubertal gynecomastia. J Pediatr Endocrinol Metab. 2012;25:753–5.10.1515/jpem-2012-0105Search in Google Scholar PubMed
[16] Akgül S, Derman O, Kanbur N. The effect of tamoxifen on pubertal bone development in adolescents with pubertal gynecomastia. J Pediatr Endocrinol Metab. 2016;29:77–83.10.1515/jpem-2015-0200Search in Google Scholar PubMed
[17] Esenboğa S, Akgül S, Kanbur N, Tüzün Z, Derman O. The effect of gynecomastia on body image perception and gender roles in adolescents. Turk J Pediatr. 2015;57:60–7.Search in Google Scholar PubMed
[18] Love RR. Tamoxifen therapy in primary breast cancer: biology, efficacy, and side effects. J Clin Oncol. 1989;7(6):803–15.10.1200/JCO.1989.7.6.803Search in Google Scholar PubMed
[19] Sawka CA, Pritchard KI, Paterson AH, Sutherland DJ, Thomson DB, Shelley WE, et al. Role and mechanism of action of tamoxifen in premenopausal women with metastatic breast carcinoma. Cancer Res. 1986;46(6):3152–6.Search in Google Scholar PubMed
[20] Selby C. Sex hormone binding globulin: origin, function and clinical significance. Ann Clin Biochem. 1990;27(6):532–41.10.1177/000456329002700603Search in Google Scholar PubMed
[21] Hammond GL. Diverse roles for sex hormone-binding globulin in reproduction. Biol Reprod. 2011;85(3):431–41.10.1095/biolreprod.111.092593Search in Google Scholar PubMed PubMed Central
[22] Kim M, Gupta M, Travers S, Rogers D, Van Lente F, Faiman C. Serum prostate specific antigen, sex hormone binding globulin and free androgen index as markers of pubertal development in boys. Clin Endocrinol. 1999;50(2):203–10.10.1046/j.1365-2265.1999.00636.xSearch in Google Scholar PubMed
[23] Vieira J, Nishida S, Pereira A, Arraes R, Verreschi I. Serum levels of prostate-specific antigen in normal boys throughout puberty. J Clin Endocrinol Metab. 1994;78(5):1185–7.10.1210/jcem.78.5.7513717Search in Google Scholar PubMed
[24] Zoeller RT, Brown T, Doan L, Gore A, Skakkebaek N, Soto A, et al. Endocrine-disrupting chemicals and public health protection: a statement of principles from The Endocrine society. Endocrinology. 2012;153(9):4097–110.10.1210/en.2012-1422Search in Google Scholar PubMed PubMed Central
[25] Shea KM. Pediatric exposure and potential toxicity of phthalate plasticizers. Pediatrics. 2003;111(6):1467–74.10.1542/peds.111.6.1467Search in Google Scholar PubMed
[26] Sibonga JD, Evans GL, Hauck ER, Bell NH, Turner RT. Ovarian status influences the skeletal effects of tamoxifen in adult rats. Breast Cancer Res Treat. 1996;41(1):71–9.10.1007/BF01807038Search in Google Scholar PubMed
[27] Kinsella C, Landfair A, Rottgers SA, Cray JJ, Weidman C, Deleyiannis FW, et al. The psychological burden of idiopathic adolescent gynecomastia. Plast Reconstr Surg. 2012;129(1):1–7.10.1097/PRS.0b013e3182361efdSearch in Google Scholar PubMed
[28] Alagaratnam T. Treating puberty gynecomastia. JR Coll Gen Pract. 1987;37(297):178.Search in Google Scholar
[29] Atabek ME. Gynecomastia in puberty is usually asymptomatic and regresses spontaneously. J Pediatr Endocrinol Metab. 2013;26(5-6):605.10.1515/jpem-2012-0403Search in Google Scholar PubMed
© 2019 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Editorial
- Adverse effects of stimulant medications in children and adolescents: focus on cardiovascular issues
- Original Articles
- Factors contributing to intentional injuries in Iranian university students
- Anxiety and depression mediate the role of low self-esteem and low self-directedness in the development of eating disorders
- The effects of music therapy on transition outcomes in adolescents and young adults with sickle cell disease
- Reducing barriers to primary school education for girls in rural Kenya: reusable pads’ intervention
- Pubertal gynecomastia: years of progress – the Hacettepe experience
- A web-based anger management program for parent-female adolescents’ conflicts: a cluster randomized controlled trial
- Chronic pain in high school students is associated with physical activity and sleeping hours but not with screen time
- Effect of Melissa officinalis capsule on the mental health of female adolescents with premenstrual syndrome: a clinical trial study
- Meningococcal disease awareness and meningoccocal vaccination among Greek students planning to travel abroad
- Parent educators for teenage smoking behavior
- Identification of common words to improve self-confidence in Japanese students with subthreshold depression
- Diet quality, overweight and daily monetary allowance of Greek adolescents
Articles in the same Issue
- Editorial
- Adverse effects of stimulant medications in children and adolescents: focus on cardiovascular issues
- Original Articles
- Factors contributing to intentional injuries in Iranian university students
- Anxiety and depression mediate the role of low self-esteem and low self-directedness in the development of eating disorders
- The effects of music therapy on transition outcomes in adolescents and young adults with sickle cell disease
- Reducing barriers to primary school education for girls in rural Kenya: reusable pads’ intervention
- Pubertal gynecomastia: years of progress – the Hacettepe experience
- A web-based anger management program for parent-female adolescents’ conflicts: a cluster randomized controlled trial
- Chronic pain in high school students is associated with physical activity and sleeping hours but not with screen time
- Effect of Melissa officinalis capsule on the mental health of female adolescents with premenstrual syndrome: a clinical trial study
- Meningococcal disease awareness and meningoccocal vaccination among Greek students planning to travel abroad
- Parent educators for teenage smoking behavior
- Identification of common words to improve self-confidence in Japanese students with subthreshold depression
- Diet quality, overweight and daily monetary allowance of Greek adolescents
