A Case Of Gynecomastia

A 60-year-old alcoholic man, currently being treated for gastritis, presents to the office with painful breasts that appear enlarged. The most likely cause is

A) Breast cancer
B) Excessive calcium carbonate ingestion
C) Omeprazole use
D) Trauma
E) Prolactinoma

Answer And Discussion:
The answer is C. (Omeprazole use)

Gynecomastia is a condition characterized by enlargement of the breasts in men. It occurs when there is hypertrophy of breast tissue beneath the areola. In young adolescents, it is a natural response to the body’s hormones. During this time, the breast may be tender. Patients and their parents should be reassured this is a natural response and will eventually resolve (usually within 3 years).


Gynecomastia in older men can result from :

• medication use (e.g.,omeprazole and cimetidine, INH, digitalis, phenothiazine, testosterone),
• substance abuse (e.g., alcohol; illegal drugs, including marijuana and heroin), 
• endocrine disorders (e.g., hypogonadism, hyperthyroidism),
• Klinefelter’s syndrome, 
• liver disease, and 
• neoplasm. 

The workup of gynecomastia should include a chest radiograph, β-human chorionic gonadotropin determination, luteinizing hormone, β-FSH, estrogen and testosterone levels, liver function tests, and thyroid function tests.
Typically, the estrogen:testosterone ratio is high.
If the human chorionic gonadotropin is elevated, then a testicular ultrasound should be performed
to look for testicular tumor. Additionally, if the testes are small, a karyotype should be obtained to look for Klinefelter’s syndrome. Other testing may be necessary, if indicated.

Treatment involves stopping any offending medications and correcting the underlying abnormality. If the condition does not resolve, suppressive medication or surgery may be indicated.