Natural Treatment Of Gynecomastia Exercise

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Spironolactone Induced Gynecomastia

The pathophysiology of gynecomastia after spironolactone administration has been carefully studied in man. As noted above, spironolactone induces gynecomastia (and other antiandrogenic effects) principally by binding to cytosolic androgen receptors. Subsequently, in patients who develop gynecomastia, blood testosterone levels decrease and blood estradiol levels increase. These changes come about by increases in metabolic clearance rate of testosterone as well as an increase in peripheral conversion to estradiol. Consequently, excessive stimulation of breast tissue as a result of an imbalance between estrogen and testosterone in the body leads to increased ductal proliferation and tender breast enlargement in males. Discontinuation of the drug results in slow reversal of this process sometimes requiring several months for complete normalization of breast size.

Gynecomastia

About 10 of choriocarcinoma of the testis and 15 - 20 of gonadal stroma sex cord testicular tumors induce gynecomastia through their autonomous synthesis and secretion of estrogens. Tumor estrogen production may also cause decreased libido and poor sperm quality. The diagnosis of these hormone producing tumors is usually clinically evident from the finding of a testicular swelling that might be painless or painful. Occasionally the sole presenting feature is gynecomastia or very rarely decreased potency and no palpable testicular lesion (Lemack et al. 1995 Haas et al. 1989). Under these circumstances the diagnosis of testicular neoplasia may be missed. The presence of such occult tumors may be suspected from the biochemical findings of raised serum estrogens and depressed testosterone hormone levels. However, this does not always apply as some clinically recognizable estrogenic tumors have been reported in patients with normal hormonal profiles. Although gy-necomastia is a relatively...

Is DNA Hypomethylation Like DNA Hypermethylation Sometimes Associated with Tumor Progression

In contrast, there is evidence for the early appearance of DNA hypomethylation during some types of tumorigenesis. Goelz et al71 found hypomethylation of 3-4 of10 examined genes by Southern blot analysis with CpG methylation-sensitive restriction endonucleases in adenomatous colon polyps from seven patients. Five of those patients had colon cancers also displaying hypomethylation of the same genes. In collaboration with Andy Feinberg and Charles Gehrke, we compared colon tumors and adjacent apparently normal tissue. We found that there was a reproducible decrease in global DNA methylation levels of about 8 in eight colonic polyps from colon cancer patients.74 Ribieras and coworkers observed hypomethylation of the A-y globin gene in two samples of lobular carcinoma in situ, an early stage of breast cancer.72 However, we found that only one of 19 samples from abnormal but nonmalignant breast tissue showed moderate-to-strong hypomethylation of Sat2 compared with almost half of 25...

Pharmacological Management of Undernutrition

Gynecomastia and hypoglycemia were noted furthermore, the increase in muscle bulk failed to produce a parallel increase in muscle strength. Inadequate data regarding the safety and efficacy of growth hormone administration precludes routine clinical use. Similarly, the role of insulin-like growth factor (IGF-I) in the management of undernutrition is questionable. Although the data suggest that exo-genously administered IGF-I may enhance nitrogen retention, gluconeogenesis, and maintenance of normal gastrointestinal function, evidence-based outcome studies are lacking.

Clinical Features

Physical findings of acute hepatitis are often limited to moderate enlargement of the liver and tenderness. Chronic liver disease is accompanied by a host of physical findings, including sallow complexion, appendicular wasting, palmar erythema, distinctive cutaneous spider nevi, parotid gland enlargement, and testicular atrophy and gynecomastia in males. Ihe liver may be uniformly enlarged and firm or, in advanced cirrhosis, shrunken and grossly nodular. Splenomegaly and ascites accompany portal hypertension.

Potassium Sparing Diuretics

These diuretics are the sodium channel blockers amiloride and triamterene and the antialdosterone spironolactone. They all have weak natriuretic effects and are antikaliuretic (see Fig. 6). Spironolactone is specifically indicated in hypertension due to primary mineralocorticoid excess, although in adrenal hyperplasia and hyperaldosteronism amiloride may prove more effective in maintaining plasma potassium and controlling BP. The main problem with spironolactone is that doses above 100 mg daily are usually poorly tolerated because of nausea and gynecomastia in men, although it does have a useful antiacne and antiandrogen effect in some women (e.g., polycystic ovary disease). Moreover, there is concern that long-term use may be associated with an increased risk of hematological malignancy. These agents are more commonly used to prevent thiazide and loop diuretic induced hypokalemia, particularly in patients on digoxin or with ischemic heart disease and a history of life-threatening...

Antiandrogenic Effects

Caminos-Torres, R., Ma, L., and Snyder, R J. Gynecomastia and semen abnormalities induced by spironolactone in normal men. J. Clin. Endocrinol. Metab. 45, 255. 3. Dupont, A. (1985). Disappearance of spironolactone-induced gynecomastia during treatment with potassium canrenoate. The Lancet September, 731. 9. Rose, L. I., Underwood, R. H., Newmark, S. R., Kisch, E. S., and Williams, G. H. (1977). Pathophysiology of spironolactone-induced gynecomastia. Ann. Int. Med. 87, 398-403.

Clinical Consequences

The incidence of spironolactone-induced gynecomastia in men is dose related (Fig. 3). It is estimated that 50 of men treated with Si50 mg day of spironolactone will develop gynecomastia. The degree of gynecomastia varies con- FIGURE 3. Incidence of gynecomastia according to dose of spironolactone. From Juenema-tire, et al. siderably from patient to patient but in most instances causes mild symptoms. Associated breast tenderness is common but an inconsistent feature. Regression of gynecomastia usually occurs within a few weeks after discontinuation of spironolactone. More troubling symptoms and signs in some males include reduced libido and impotence however, the incidence of these complaints is not known. These effects are also dose-dependent and disappear after discontinuation of the drug.

Human Chorionic Gonadotropin

Elevation of human chorionic gonadotropin (hCG) associated with renal cell carcinoma RCC has been reported (McCloskey and O'Connor 1982 Golde et al. 1974 Fukutani et al. 1983). In males, clinical findings include gynecomastia, decreased libido, and elevated urine and serum hCG levels. Only a small number of cases have been reported, though there is no direct evidence of tumor production of these hormones. Gy-necomastia and increased urinary levels gonadotro-pins associated with RCC have been reported with resolution of the endocrine abnormality following ne-phrectomy (Laski and Vugrin 1987).

Physical Examination

Cool, clammy skin is an obvious sign of shock. Spider angiomata, palmar erythema, jaundice, and gynecomastia suggest underlying liver disease. Petechiae and purpura suggest an underlying coagulopathy. Skin findings may be suggestive of the Peutz-Jeghers, Rendu-Osler-Weber, or Gardner syndromes. A careful ENT examination may occasionally reveal an occult bleeding source that has resulted in swallowed blood and subsequent coffee-ground emesis or melena. The abdominal examination may disclose tenderness, masses, ascites, or organomegaly. A rectal examination is indicated to detect the presence of blood, its appearance (bright red, maroon, or melanotic), and the presence of masses.

Diet and Bed Rest

Many spironolactone side-effects result from its potent antiandrogenic activity. Indeed, this side-effect has been effectively employed to treat patients with hyperandrogenic hirsutism and or acne. This effect can cause painful gynecomastia in many patients receiving this drug. The electrolyte derangements produced by spironolactone include hyperkalemia and hyperchloremic metabolic acidosis. They occur with increased frequency in patients with a reduced renal function.

Chromosome Disorders

Klinefelter's syndrome is a sex chromosome abnormality that occurs in 1 of 600 males, with a karyotype of 47. Individuals with Klinefelter's syndrome possess an extra X chromosome XXY. Clinical characteristics are variable and include some learning and developmental disabilities, hypogonadism, small testes, and gynecomastia occuring in puberty. The condition can be managed by administering testosterone supplements beginning in adolescence. As with some other sex chromosome abnormalities, adults with Klinefelter's syndrome are usually infertile. gynecomastia excessive breast development in males

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