Gynecomastia, enlargement of the breast tissue, can be a normal physiologic occurrence or be due to a disease state or medication. It is relatively common in adolescent boys.
When gynecomastia is related to medication use, the mechanism for the excessive breast tissue development is an impaired balance in the serum estrogen / serum androgen ratio, or a rise in prolactin level. Medications can act directly as estrogens or cause an increase in estrogen.
Medications with strong evidence include antiandrogens, sex hormones, spironolactone, cimetidine, verapamil, and chemotherapy (especially alkylating agents). Tricyclic antidepressants, neuroleptics, calcium channel blockers, omeprazole, sulpiride, captopril, digitalis glycosides, and some antibiotics and growth hormones have been reported. Once the offending medication is removed, the gynecomastia will usually resolve.
Gynecomastia secondary to antiretroviral therapy (ART) has been reported. Gynecomastia occurring from the herb "Dong Quai" has been reported.
Gynecomastia
Alerts and Notices
Synopsis
Codes
ICD10CM:
N62 – Hypertrophy of breast
SNOMEDCT:
4754008 – Gynecomastia
N62 – Hypertrophy of breast
SNOMEDCT:
4754008 – Gynecomastia
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
If a medication is not clearly the cause, consider:
- Testicular tumors (see sex cord stromal tumor)
- Hypothyroidism and hyperthyroidism
- Cushing syndrome
- Liver disease
- Hodgkin disease
- Androgen resistance syndromes
- Klinefelter syndrome
- Male pseudohermaphroditism
- Testicular feminization syndrome
- Leukemia
- Hemophilia
- Chronic glomerulonephritis
- Pseudogynecomastia
- Male breast cancer
- Benign breast lesion (abscess, intraductal cyst, papilloma, fibroadenoma, phyllodes tumor, lymphangioma, hemangioma, lipoma)
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Updated:10/28/2021
Gynecomastia