The mysterious ginekomastiya of
the Female breast is very important and, we will notice, beautiful body! Truly, but only at the woman. Today it will be a question of mammary glands at men who normal are rudimental and unnecessary organ and are called chest glands.
the Term “ginekomastiya“ as well as many medical terms “is“ from Greek. The Greek gyne, gynaikos is translated as the woman, and mastos - a breast, that is a female breast. So, a state when at the man chest gland increases, call a ginekomastiya. And increase can be observed as on the one hand, and from both.
, the problem is How actual?Ginekomastiya is extended by
more than can seem to us at first sight. Even in the ancient world of the man were familiar with this problem. According to the Greek mythology the ginekomastiya developed at those males who led an unseemly life.
Agree, the man with a female breast - it is strange. For this reason this state causes the mass of psychological problems to the owners.cannot be spoken to
About a ginekomastiya as about 100%om a disease. Not always increase in chest glands at the man is an illness. However, can define with the greatest degree of probability problem option only the doctor.
the First major issue which is resolved by the doctor at the address of the patient to him - what type of a ginekomastiya takes place to be? Namely, true or false.
About a false ginekomastiya is told when chest gland increases at the expense of fatty tissue. In this case to the man the general weight reduction and physical activities will help to get rid of “breast“.the Situation with a true ginekomastiya is far more difficult than
. Nevertheless at once you should not panic. Why? For one simple reason - the true ginekomastiya also is not always an illness. Yes, the ginekomastiya is normal during three periods of life of the man. It is a so-called physiological ginekomastiya.
the Physiological ginekomastiya is a state which is caused by influence of female sex hormones. It absolutely normally also is just next stage of development of a man`s organism.
When the man can meet such ginekomastiya?
- of Ginekomastiya of the newborn. The female sex hormones which got till the birth from a placenta in an organism of the boy cause swelling of chest glands. Meets rather often, but not always. In several weeks chest glands return to normal.
- Teenage (juvenile, pubertatny) ginekomastiya. This type of a physiological ginekomastiya develops at young men and becomes frequent the reason of psychological problems, especially, if signs do not pass more or less long period of time. Swelling of chest glands at the man arises when the man`s part of hormonal system is still imperfect, and female is active (about 13 - 14 years). The size of glands (fortunately, it is very rare) is comparable with a size of a female breast. Statistically among all young people of 70% are familiar with ginekomastiya symptoms. Treatment is necessary when mammary glands not completely returned to a normal state. In these cases surgeons come to the rescue.
- the Third stage of a physiological ginekomastiya - a ginekomastiya of advanced age. The emergence reason - decrease in synthesis of male sex hormones (testosterone) owing to what estrogen prevails. During this period of life of the man there are enough reasons for development of a pathological ginekomastiya what it is necessary to remember. But about it later.
the Pathological ginekomastiya
According to the classification accepted around the world (on Frantz F. G., Wilson J. D. Endocrine disorders of the breast. Williams textbook of endocrinology 1998; page 877 - 900), depending on the reasons which caused pathology, a ginekomastiya shares on:
- the Pathological ginekomastiya
- Deficiency of testosterone
- Congenital defects
- Congenital anarchy (lack of testicles and an underdevelopment of genitals)
- Klaynfelter`s Syndrome
- Resistance to androgens (Morris`s syndrome - testikulyarny feminization - and Reyfenstein`s syndrome)
- Defects in testosterone synthesis
- Secondary testikulyarny insufficiency (virus orkhit, a trauma, castration, neurologic and granulematozny diseases, a renal failure).
- the Raised production of estrogen
- the Raised testikulyarny production of estrogen
- of the Tumour of testicles
- the Bronkhogenny cancer and other tumors producing horionichesky gonadotropny hormone (HG)
- the True hermaphroditism
- Increase in a substratum for an ekstraglandulyarny aromataza
- of the Disease of adrenal glands
- of the Disease of a liver
- the Thyrotoxicosis
- Increase in an ekstraglandulyarny aromataza
- the Estrogen and preparations operating like estrogen (dietilstilbestrol, estrogensoderzhashchy cosmetics, contraceptives, estrogensoderzhashchy food, phytoestrogen).
- the Preparations strengthening endogenous formation of estrogen (a gonadotrophin of horionicheskiya, clomifene).
- Preparations, the oppressing syntheses of testosterone or its action (ketokonazol, metronidazole, tsimetidin, etomidat, alkiliruyushchy preparations, flutamid, spironolakton).
- Preparations with the action mechanism, unspecified concerning a ginekomastiya (an isoniazid, a metildop, blockers of calcic channels, captopril, tritsiklichesky antidepressants, penitsillamin, diazepam, and also marijuana, heroin, etc.) .
In other words, the reason of development of a ginekomastiya - prevalence of estrogen (female sex hormones). However such prevalence can be true (hyperproduction of estrogen) or relative when synthesis of men`s hormones is reduced.
To relative deficiency of testosterone (decrease in its education) are led by many states. The separate attention is deserved such as Klaynfelter`s syndrome, testikulyarny feminization, Reyfenstein`s syndrome, secondary testikulyarny insufficiency (result of such diseases as virus orkhit, a trauma, castration, neurologic and granulematozny diseases, a renal failure) also by defects in testosterone synthesis.
Klaynfelter`s Syndrome is a genetic disease. Men have a certain look the set of chromosomes defining external signs: high growth, long extremities, an evnukhoidizm, a ginekomastiya, the increased release of female sex hormones, tendency to obesity, and also violations of mentality. Unfortunately, its prevalence is not so small as it would be desirable. Treatment is carried out by male sex hormones for correction of secondary sexual characteristics.feminization and Reyfenstein`s syndrome are united by
of Testikulyarnaya in one group. Both states are caused by tolerance (resistance) of cages to testosterone. Therefore there is an obstacle in a way of testosterone to cages. That is it is, but cannot affect fabrics.
the Syndrome of testikulyarny feminization develops when cages have a defective structure and cannot accept testosterone (there are no receptors). The set of chromosomes at the same time is characteristic of men, and appearance - female therefore the syndrome is called also psevdogermafrodizmy. The underdevelopment of genitals takes place and there are almost always testicles. Treatment of this syndrome does not exist.
Reyfenstein`s Syndrome - a genetic disease which essence also consists in violation of sensitivity of fabrics to androgens. Reyfenstein`s syndrome on external signs is similar to Klaynfelter`s syndrome: a gipospadiya (anomaly of development of a penis at which the wrong arrangement of an opening of an urethra is observed), a ginekomastiya, an evnukhoidizm, an atrophy of seed tubules and quite often an azoospermiya (absence in semen of spermatozoa - infertility).
Treatment in this case is reduced to replacement therapy by androgens.
Secondary testikulyarny insufficiency
states at which the ginekomastiya is one of collateral states or complication Exist. For example, the renal failure, gipertireoz, cirrhosis, virus orkhit, traumatic defeats and others. In this case to the forefront, of course, there is a treatment of the main disease and as far as possible correction of a gineokmastiya.Ginekomastiya`s
, caused by hyperproduction (excess development) of estrogen.
the Second major group of the reasons of emergence of the increased mammary glands in men is hyperproduction of estrogen. Enters into this group smaller by quantity, but much more dangerous states. For example, tumors of testicles, bronkhogenny cancer, tumors of adrenal glands, true hermaphroditism, liver diseases, starvation, thyrotoxicosis, increase in an ekstraglandulyarny aromataza. Patients need an integrated approach, sometimes long-term treatment and a ginekomastiya gains smaller value in comparison with the main disease.
Medicines In classification you, of course, paid attention to medicines. Let`s talk about them. The conducted researches showed that more than 50% of patients with a ginekomastiya accepted 1 or several preparations. The part of them possess hormonal action, and part - break function of genitals. The help in this case consists in cancellation of the preparation which caused a ginekomastiya. However it happens that it is not possible to cancel medicine. Then, having estimated usefulness and risk, the doctor will make the decision on cancellation of a preparation.
How to understand that the ginekomastiya appeared? Normal at the man we see only a nipple. At palpation of chest gland no consolidations or educations should be. Increase in sizes of chest glands (symmetric or unilateral), their morbidity, hypersensibility and consolidation of fabric around one or both nipples - the first signs of a ginekomastiya. Also the patient can complain of feeling of weight, a raspiraniye and unpleasant feelings in a mammary gland.
Attention! Consolidations, educations out of an areola, allocations from a nipple (including bloody), increase in regional lymph nodes, changes of skin in the field of chest glands are the signs which do not have relations to a ginekomastiya. In this case it is necessary to see urgently a doctor to exclude a malignant new growth. Let`s note that malignant processes of chest glands at men arise extremely seldom, approximately by 100 times less than at women, but it is necessary to secure itself.
Where to run?
Very often before the man the question rises: and what expert to address? The address both to the surgeon, and to the mammologist or the endocrinologist is right. The problem very versatile and is better to get advice of all experts.As the doctor will make to
At first the doctor will in detail ask the alleged patient. Therefore before a campaign to the doctor try to remember how long chest glands began to increase whether it was followed by painful feelings, whether there were changes of sexual desire, pain or discomfort in testicles, and also fluctuations of weight for this period of time.
It is important! What preparations the patient accepts or accepted, nature of food, chronic diseases and genetic features of a sort, what diseases were transferred by the patient.
Further the doctor will examine the patient proceeding from what he will appoint additional researches.
the Obligatory stage of diagnostics. Depending on the obtained data also tool methods can be shown: mammography, ultrasonography of a mammary gland, ultrasonography and biopsy of testicles, inspection of adrenal glands, ultrasonography of a thyroid gland, radiological research of a skull, thorax, research of function of a liver.
At suspicion on a breast cancer tissues of a mammary gland conduct research.
How to treat?
Treatment of a ginekomastiya directly depends on its look.
If the physiological ginekomastiya arises, then it passes by itself. The only recommendation at a ginekomastiya pubertatny age - to increase physical activities.
If we deal with a false ginekomastiya, the diet and general measures on weight reduction is appointed.the True pathological ginekomastiya is treated by
differently depending on a stage of the development. Allocate 3 stages:
- the Developing (proliferiruyushchy) ginekomastiya. Duration - 4 months.
- the Intermediate stage to last from 4 months to 1 year
- the Fibrous stage is characterized by emergence in a mammary gland of mature connecting fabric, adjournment of fatty tissue around ferruterous fabric.
At an initial stage can fight against a ginekomastiya by conservative methods, namely to appoint preparations for correction of a ratio testosterone / estrogen. At correctly picked up therapy chest gland completely comes back to the initial sizes. In a case when there is a lack of testosterone appoint its preparations, and in a case when there is an excess of estrogen appoint the preparations blocking impact of estrogen on a mammary gland.Already since the second stage, a full solution by means of preparations does not manage to be achieved
. Here the help of the surgeon is required if conservative therapy was all - powerless.
I at the last stage only the surgeon can solve a problem. Surgical treatment is shown always when conservative therapy was inefficient. Even if the ginekomastiya does not constitute danger, but the psychological state of the patient suffers, surgical treatment is also shown.
the Key moment in treatment of a ginekomastiya is elimination of the reason of development of a problem. However it is not always possible to affect the ginekomastiya reason (for example, medicines). At the choice of treatment it is necessary to weigh very strictly everything pros and cons, especially if it is about chronic diseases and oncological processes.