Ginecomastia
fisiopatologia, avaliação e tratamento
Palavras-chave:
Mama, Ginecomastia, Cirurgia, Adolescente, Doenças do sistema endócrinoResumo
A ginecomastia (GM) é caracterizada pelo aumento do volume mamário em homens, provocada por proliferação glandular e depósito de gordura. É comum e pode ocorrer em adolescentes, adultos e idosos. O objetivo desta revisão é discutir a fisiopatologia, etiologia, avaliação clínica e terapia da GM. Um desequilíbrio entre estrogênios e androgênios é reconhecido como a condição fundamental para a determinação do quadro, podendo ser atribuído a fatores fisiológicos, tumores ou distúrbios endócrinos, doenças não-endócrinas, uso de drogas ou ser de causa idiopática. A avaliação clínica deve enfocar a confirmação diagnóstica, a procura de uma causa específica e a classificação em graus de gravidade para orientar o tratamento. Um roteiro de conduta individualizada é apresentado, variando entre perda de peso e explicações verbais, tratamento com tamoxifeno e correção cirúrgica. Para casos de GM persistente, os melhores resultados são obtidos em geral mediante abordagem cirúrgica, combinando lipoaspiração e adenectomia mamária.
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Georgiadis E, Papandreou L, Evangelopoulou C, et al. Incidence of gynaecomastia in 954 young males and its relationship to somatometric parameters. Ann Hum Biol. 1994;21(6):579-87.
Nuttall FQ. Gynecomastia as a physical finding in normal men. J Clin Endocrinol Metab. 1979;48(2):338-40.
Nydick M, Bustos J, Dale JH Jr, Rawson RW. Gynecomastia in adolescent boys. JAMA. 1961;178:449-54.
Niewoehner CB, Nuttall FQ. Gynecomastia in a hospitalized male population. Am J Med. 1984;77(4):633-8.
Bannayan GA, Hajdu SI. Gynecomastia: clinicopathologic study of 351 cases. Am J Clin Pathol. 1972;57(4):431-7.
Moore NP. The oestrogenic potential of the phthalate esters. Reprod Toxicol. 2000;14(3):183-92.
Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, et al. Endocrine- disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev. 2009;30(4):293-342.
Sasano H, Kimura M, Shizawa S, Kimura N, Nagura H. Aromatase and steroid receptors in gynecomastia and male breast carcinoma: an immunohistochemical study. J Clin Endocrinol Metabol. 1996;81(8):3063-7.
Calzada L, Torrs-Calleja J, Martinez JM, Pedrón N. Measurement of androgen and estrogen receptors in breast tissue from subjects with anabolic steroid-dependent gynecomastia. Life Sci. 2001;69(13):1465-9.
Rosen H, Webb ML, DiVasta AD, et al. Adolescent gynecomastia: not only an obesity issue. Ann Plast Surg. 2010;64(5):688-90.
Dimitrakakis C, Zhou J, Wang J, et al. A physiologic role for testosterone in limiting estrogenic stimulation of the breast. Menopause. 2003;10(4):292-8.
Pearlman G, Carlson HE. Gynecomastia: an update. The Endocrinologist. 2006;16(2):109-15. Available from: http://www.mendeley.com/ research/gynecomastia-update/. Accessed in 2011 (Oct 19).
Braunstein GD. Clinical practice. Gynecomastia. N Engl J Med. 2007;357(12):1229-37.
Narula HS, Carlson HE. Gynecomastia. Endocrinol Metab Clin North Am. 2007;36(2):497-519.
Thompson DF, Carter JR. Drug-induced gynecomastia. Pharmacotherapy. 1993;13(1):37-45.
Ismail AA, Barth JH. Endocrinology of gynaecomastia. Ann Clin Biochem. 2001;38(Pt 6):596-607.
Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc. 2009;84(11):1010-5.
Braunstein GD. Environmental gynecomastia. Endocr Pract. 2008;14(4):409-11.
Durmaz E, Ozmert EN, Erkekoglu P, et al. Plasma phthalate levels in pubertal gynecomastia. Pediatrics. 2010;125(1):e122-9.
Stroheker T, Cabaton N, Nourdin G, et al. Evaluation of anti-androgenic activity of di-(2-ethylhexyl)phthalate. Toxicology. 2005;208(1):115-21.
Agency for Toxic Substances and Disease Registry. Toxicological profile for di-(2-ethylhexyl)-phthalate. Atlanta: Department of Health and Human Services, Public Health Service, Agency for Toxic Substances and Disease Registry; 2002. Available from: http://www. atsdr.cdc.gov/toxprofiles/tp9-p.pdf. Accessed in 2011 (Oct 19).
Sattin RW, Roisin A, Kafrissen ME, Dungan JB, Farer LS. Epidemic of gynecomastia among illegal Haitian entrants. Public Health Rep. 1984;99(5):504-10.
Brody SA, Loriaux DL. Epidemic of gynecomastia among haitian refugees: exposure to an environmental antiandrogen. Endocr Pract. 2003;9(5):370-5.
Carlson HE, Kane P, Lei ZM, Li X, Rao CV. Presence of luteinizing hormone/human chorionic gonadotropin receptors in male breast tissues. J Clin Endocrinol Metab. 2004;89(8):4119-23.
Bird J, Li X, Lei ZM, et al. Luteinizing hormone and human chorionic gonadotropin decrease type 25 alpha-reductase and androgen receptor protein levels in women’s skin. J Clin Endocrinol Metab. 1998;83(5):1776-82.
Ruan W, Monaco ME, Kleinberg DL. Progesterone stimulates mammary gland ductal morphogenesis by synergizing with and enhancing insulin-like growth factor-I action. Endocrinology. 2005;146(3):1170-8.
Farthing MJ, Green JR, Edwards CR, Dawson AM. Progesterone, prolactin, and gynaecomastia in men with liver disease. Gut. 1982;23(4):276-9.
Nomura K, Suzuki H, Saji M, et al. High serum progesterone in hyperthyroid men with Graves’ disease. J Clin Endocrinol Metab. 1988;66(1):230-2.
Gill S, Peston D, Vonderhaar BK, Shousha S. Expression of prolactin receptors in normal, benign, and malignant breast tissue: an immunohistological study. J Clin Pathol. 2001;54(12):956-60.
Correll CU. Effect of hyperprolactinemia during development in children and adolescents. J Clin Psychiatry. 2008;69(8):e24.
Ormandy CJ, Hall RE, Manning DL, et al. Coexpression and cross- regulation of the prolactin and sex steroid hormone receptors in breast cancer. J Clin Endocrinol Metab. 1997;82(11):3692-9.
Ruan W, Kleinberg DL. Insulin-like growth factor I is essential for terminal end bud formation and ductal morphogenesis during mammary development. Endocrinology. 1999;140(11):5075-81.
Braunstein GD. Gynecomastia. N Engl J Med. 1993;328(7):490-5.
Mazur T, Clopper RR. Pubertal disorders. Psychology and clinical management. Endocrinol Metab Clin North Am. 1991;20(1):211-30.
Harman SM, Metter EJ, Tobin JD, et al. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001;86(2):724-31.
Couillard C, Gagnon J, Bergeron J, et al. Contribution of body fatness and adipose tissue distribution to the age variation in plasma steroid hormone concentrations in men: the HERITAGE Family Study. J Clin Endocrinol Metab. 2000;85(3):1026-31.
Ford HC, Cooke RR, Keightley EA, Feek CM. Serum levels of free and bound testosterone in hyperthyroidism. Clin Endocrinol (Oxf ). 1992;36(2):187-92.
Lanfranco F, Kamischke A, Zitzmann M, Nieschlag E. Klinefelter’s syndrome. Lancet. 2004;364(9430):273-83.
Magro G, Gangemi P, Villari L, Greco P. Deciduoid-like stromal cells in a diabetic patient with bilateral gynecomastia: a potential diagnostic pitfall. Virchows Arch 2004;445(6):659-60.
García-Benayas T, Blanco F, Martín-Carbonero L, et al. Gynecomastia in HIV-infected patients receiving antiretroviral therapy. AIDS Res Hum Retroviruses. 2003;19(9):739-41.
Eckman A, Dobs A. Drug-induced gynecomastia. Expert Opin Drug Saf. 2008;7(6):691-702.
Goldman RD. Drug-induced gynecomastia in children and adolescents. Can Fam Physician. 2010;56(4):344-5.
Holzbeierlein JM. Managing complications of androgen deprivation therapy for prostate cancer. Urol Clin North Am. 2006;33(2):181-90, vi.
Sauer MA, Rifka SM, Hawks RL, Cutler GB Jr, Loriaux DL. Marijuana: interaction with the estrogen receptor. J Pharmacol Exp Ther. 1983;224(2):404-7.
Basaria S. Androgen abuse in athletes: detection and consequences. J Clin Endocrinol Metab. 2010;95(4):1533-43.
Hines SL, Tan WW, Yasrebi M, DePeri ER, Perez EA. The role of mammography in male patients with breast symptoms. Mayo Clin Proc. 2007;82(3):297-300.
Dialani V, Baum J, Mehta TS. Sonographic features of gynecomastia. J Ultrasound Med. 2010;29(4):539-47.
Olsson H, Bladstrom A, Alm P. Male gynecomastia and risk for malignant tumours--a cohort study. BMC Cancer. 2002;2:26.
Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet. 2006;367(9510):595-604.
Korde LA, Zujewski JA, Kamin L, et al. Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol. 2010;28(12):2114-22.
Sasco AJ, Lowenfels AB, Pasker-de Jong P. Review article: epidemiology of male breast cancer. A meta-analysis of published case-control studies and discussion of selected aetiologic factors. Int J Cancer. 1993;53(4):538-49.
Hultborn R, Hanson C, Köpf I, et al. Prevalence of Klinefelter’s syndrome in male breast cancer patients. Anticancer Res. 1997;17(6D):4293-7.
Rohrich RJ, Ha RY, Kenkel JM, Adams WP Jr. Classification and management of gynecomastia: defining the role of ultrasound- assisted liposuction. Plast Reconstr Surg. 2003;111(2):909-23; discussion 924-5.
Ratnam BV. A new classification and treatment protocol for gynecomastia. Aesthet Surg J. 2009;29(1):26-31.
Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973;51(1):48-52.
Cordova A, Moschella F. Algorithm for clinical evaluation and surgical treatment of gynaecomastia. J Plast Reconstr Aesthet Surg. 2008;61(1):41-9.
Hammond DC. Surgical correction of gynecomastia. Plast Reconstr Surg. 2009;124(1 Suppl):61e-68e.
Jones DJ, Holt SD, Surtees P, Davison DJ, Coptcoat MJ. A comparison of danazol and placebo in the treatment of adult idiopathic gynaecomastia: results of a prospective study in 55 patients. Ann R Coll Surg Engl. 1990;72(5):296-8.
Buckle R. Danazol therapy in gynaecomastia; recent experience and indications for therapy. Postgrad Med J. 1979;55 Suppl 5:71-8.
Eberle AJ, Sparrow JT, Keenan BS. Treatment of persistent pubertal gynecomastia with dihydrotestosterone heptanoate. J Pedriat. 1986;109(1):144-9.
Alagaratnam TT. Idiopathic gynecomastia treated with tamoxifen: a preliminary report. Clin Ther. 1987;9(5):483-7.
McDermott MT, Hofeldt FD, Kidd GS. Tamoxifen therapy for painful idiopathic gynecomastia. South Med J. 1990;83(11):1283-5.
Khan HN, Rampaul R, Blamey RW. Management of physiological gynaecomastia with tamoxifen. Breast. 2004;13(1):61-5.
Ting AC, Chow LW, Leung YF. Comparison of tamoxifen with danazol in the management of idiopathic gynecomastia. Am Surg. 2000;66(1):38-40.
Lawrence SE, Faught KA, Vethamuthu J, Lawson ML. Beneficial effects of raloxifene and tamoxifen in the treatment of pubertal gynecomastia. J Pediatr. 2004;145(1):71-6.
Riepe FG, Baus I, Wiest S, et al. Treatment of pubertal gynecomastia with the specific aromatase inhibitor anastrozole. Horm Res. 2004;62(3):113-8.
Mauras N, Bishop K, Merinbaum D, et al. Phamacokinetics and pharmacodynamics of anastrozole in pubertal boys with recent- onset gynecomastia. J Clin Endocrinol Metab. 2009;94(8):2975-8.
Plourde PV, Reiter EO, Jou HC, et al. Safety and efficacy of anastrozole for the treatment of pubertal gynecomastia: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89(9):4428-33.
Petty PM, Solomon M, Buchel EW, Tran NV. Gynecomastia: evolving paradigm of management and comparison of techniques. Plast Reconstr Surg. 2010;125(5):1301-8.
Boccardo F, Rubagotti A, Battaglia M, et al. Evaluation of tamoxifen and anastrozole in the prevention of gynecomastia and breast pain induced by bicalutamide monotherapy of prostate cancer. J Clin Oncol. 2005;23(4):808-15.
Laituri CA, Garey CL, Ostlie DJ, et al. Treatment of adolescent gynecomastia. J Pediatr Surg. 2010;45(3):650-4.
Pitanguy I. Transareolar incision for gynecomastia. Plast Reconstr Surg. 1966;38(5):414-9.
Davidson BA. Concentric circle operation for massive gynecomastia to excise the redundant skin. Plast Reconstr Surg. 1979;63(3):350-4.
Gheita A. Gynecomastia: the horizontal ellipse method for its correction. Aesthetic Plast Surg. 2008;32(5):795-801.
Abramo AC. Axillary approach for gynecomastia liposuction. Aesthetic Plast Surg. 1994;18(3):265-8.
Ohyama T, Takada A, Fujikawa M, Hosokawa K. Endoscope-assisted transaxillary removal of glandular tissue in gynecomastia. Ann Plast Surg. 1998;40(1):62-4.
Chiu DT, Siegel HW. The pinwheel technique: an adjunct to the periareolar approach in gynecomastia resection. Ann Plast Surg. 1999;42(5):465-9.
Pine JL, Smith LJ, Haws MJ, Gingrass MK. Ultrasound-assisted lipoplasty. Plast Surg Nurs. 2003;23(3):101-8; quiz 109.
Maidment SL. Question 2. Which medications effectively reduce pubertal gynaecomastia? Arch Dis Child. 2010;95(3):237-9.
Handschin AE, Bietry D, Hüsler R, Banic A, Constantinescu M. Surgical management of gynecomastia--a 10-year analysis. World J Surg. 2008;32(1):38-44.
LanitisS,StarrenE,ReadJ,etal.SurgicalmanagementofGynaecomastia: outcomes from our experience. Breast. 2008;17(6):596-603.
Gasperoni G, Salgarello M, Gasperoni P. Technical refinements in the surgical treatment of gynecomastia. Ann Plast Surg. 2000;44(4):455-8.
Wiesman IM, Lehman JA Jr, Parker MG, et al. Gynecomastia: an outcome analysis. Ann Plast Surg. 2004;53(2):97-101.
Fruhstorfer BH, Malata CM. A systematic approach to the surgical treatment of gynaecomastia. Br J Plast Surg. 2003;56(3):237-46.
Lejour M. Evaluation of fat in breast tissue removed by vertical mammoplasty. Plast Reconstr Surg. 1997;99(2):386-93.
Goh T, Tan BK, Song C. Use of the microdebrider for treatment of fibrous gynaecomastia. J Plast Reconstr Aesthet Surg. 2010;63(3):506-10.
Hamilton S, Gault D. The tuberous male breast. Br J Plast Surg. 2003;56(3):295-300.
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