GYNCOMASTY THROUGH MEDICINAL PRODUCTS – drug telegram
Gynecomastia, the often asymmetrical and sometimes painful enlargement of the mammary gland in men, can be extremely stressful for those affected. The benign growth is said to be based on a shift in the balance of estrogenic and androgenic effects on the mammary gland to the disadvantage of androgens.1-3 Estrogens stimulate the breast tissue, and androgens inhibit this effect.4th The tactile finding – a fixed or elastic, movable “disk” of tissue concentrically below the nipple – distinguishes gynecomastia from the increase in fat in the breast area (“pseudogynecomastia”).4th The most important differential diagnosis is a malignant tumor – usually one-sided, eccentric and fixed – to be excluded, especially if the new formation does not cause pain.4.5 According to an epidemiological study, men with gynecomastia have an increased risk of breast cancer.6th
Physiologically, growth of the male breast in newborns occurs under the influence of placental hormones, during puberty and in old age with falling testosterone levels.1.2 Every fourth person with gynecomastia has no cause (“idiopathic”). Up to 20% suffer from diseases or conditions associated with endocrine disorders, such as hypogonadism, hormone-producing tumors, liver cirrhosis or malnutrition. Gynecomastia has frequently been observed in children following an unbalanced diet with meat from animals that have been fattened with hormones.
Drugs are gaining importance as triggers (Table 1).1 The Swedish Medicines Agency now rates it as the most common cause of gynecomastia.7th The path of damage is not always known. It is not certain whether these drugs also increase the risk of breast cancer.6th
With almost 1,000 reports, the H2 antagonist lies Cimetidine (TAGAMET et al; cf. at 4 , 40) at the top of the suspected drug-related gynecomastia reports submitted to the WHO center in Uppsala within 27 years (1968 to 1994) (Table 2). Cimetidine is said to displace androgens from their receptors on the mammary gland and thus increase the estrogenic effects. In addition, the ulcer agent interferes with the breakdown of estradiol.7th
In third and seventh place are the H2 blockers with a good 300 and 70 reports, respectively Ranitidine (SOSTRIL et al.) And the proton pump inhibitor
Omeprazole (ANTRA, GASTROLOC).7th In contrast to cimetidine, both anti-ulcer drugs should not impair the cytochrome P-450-dependent estradiol metabolism. In a UK case-control study, cimetidine sevenfold the risk of gynecomastia compared to non-users, while ranitidine doubled the chance.8th Like the H2 antagonists, omeprazole is also associated with sexual dysfunction (at 3 , 31).9
Long-term use of the aldosterone antagonist Spironolactone (ALDACTONE et al.) Causes the mammary glands to grow in 30% to 60% of men. Like cimetidine, spironolactone displaces dihydrotestosterone, the active form of testosterone, from its receptor.2 In addition, the steroid-like hormone antagonist is said to reduce testosterone synthesis4 and promote the breakdown of androgen and the peripheral conversion into estradiol.2
First in Italy in 199210 introduced Finasteride (PROSCAR) ranks fourth in the WHO directory just two years later with almost 250 reports of gynecomastia.7th In connection with the 5-alpha reductase inhibitor used in benign prostatic hyperplasia, sexual dysfunction with loss of libido and impotence dominate (at 12 , 114). By blocking the metabolism to dihydrotestosterone, more testosterone in adipose tissue could be converted to estradiol.11th Finasteride has also been linked to breast cancer in two men (at 10 , 93).12th
The estrogen-like steroid structure of digitalis may play a role if the male breast enlarges under cardiac glycosides.1.7
Explanations for by Calcium channel blockers caused breast growth (at 3 , 31) are missing. Direct hormone-like effects could play a role (at 12 , 128). An increase in prolactin is described in connection with verapamil (ISOPTIN and others). 13 Whether prolactin here or in the Neuroleptics-induced gynecomastia indirectly through influences on the gonadal and adrenal gland function the breast enlarges remains to be clarified.7.13 Calcium channel blockers are also suspected of increasing the risk of breast cancer in women (at 12 , 128).14th
Hormones with estrogen-like effects such as polyestradiol phosphate (ESTRADURIN) for the treatment of metastatic prostate cancer can be expected to cause severe gynecomastia.1.2 Systemically sufficient amounts of female sex hormones are also absorbed from hair lotions.4th With breast enlargement, antiandrogens such as cyproterone acetate (ANDROCUR et al.), Flutamide (FUGEREL et al .; at 7 , 68) and bicalutamide (CASODEX), LH-RH agonists such as goserelin (ZOLADEX) and human chorionic gonadotropin (PRIMOGONYL etc.). By peripheral metabolism into estrogens, androgens and anabolic steroids also favor the development of a female breast.1, 2
Among the drugs suspected in the NETWORK, the calcium antagonist nifedipine (ADALAT et al.) Dominates with six reports. Two are due to the external use of the antifungal agent ketoconazole (TERZOLINE solution; 5922 and 8605), one each to the calcium antagonists nicardipine (ANTAGONIL; 4703) and verapamil (VERAPAMIL AL; 7960) as well as simultaneous therapy with nitrendipine (BAYOTENSIN), enalapril PRES), Digitoxin (DIGIMERCK MINOR) et al. (4137). In addition, growth of the mammary gland is controlled once with the H2 antagonists ranitidine (SOSTRIL; 1058) and famotidine (PEPDUL; 2217), the antiepileptics phenytoin (ZENTROPIL; 2172) and valproic acid (ORFIRIL; 3986), the neuroleptics sulpiride (DOGMATIL FORTE 2994) and clozapine (LEPONEX 8886) and the antimycotic itraconazole (SEMPERA; 6014).
TREATMENT: Drug-induced gynecomastia generally resolves after the trigger is stopped.1.2 However, it may take a few months for complete healing.15th Careful medication history may save those affected from unnecessary examinations or even interventions. Because of the high rate of spontaneous healing, the benefit of drug intervention can only be ensured through large, placebo-controlled examinations.4th We do not find convincing studies. For the occasionally recommended antiestrogen tamoxifen (NOLVADEX, among others) is a benefit only in two small randomized studies with a total of 16 Participants described.3.4 Tamoxifen is also mentioned in connection with the formation of gynecomastia.16 If the findings are pronounced and the symptoms persist, surgical removal of mammary gland tissue can be considered. 4
CONCLUSION: Numerous drugs stimulate male mammary gland growth. In addition to hormone preparations, the aldosterone antagonist spironolactone (ALDACTONE, etc.), ulcer drugs such as cimetidine (TAGAMET, etc.) and ranitidine (ZANTIC, etc.) as well as the prostate drug finasteride (PROSCAR) pose a particular risk. After the triggering agent is stopped, the gynecomastia usually resolves. There is no reliable drug treatment.
Thanks for visiting we hope our article GYNCOMASTY THROUGH MEDICINAL PRODUCTS – drug telegram
, we invite you to share the article on Facebook, twitter and e-mail with the hashtag ☑️ #GYNCOMASTY #MEDICINAL #PRODUCTS #drug #telegram ☑️!