Gynaecomastia

Side-effects associated with testosterone include headache, hirsutism and gynaecomastia. 

CS348 Daniels, 1. R. and G. T. Layer. How should gynaecomastia be managed ... 

Adverse effects include dry mouth, tachycardia, palpitation, impotence, constipation, difficulty in accommodation, rarely hyperpyrexia and paralytic ileus lethargy, headache, drowsiness, tremors, ataxia, sweating, convulsion, urticaria, skin rash, pruritus, cholestatic jaundice, cardiac arrhythmias, orthostatic hypotension, agranulocytosis, gynaecomastia, galactorrhoea and dependence loss of weight or gain. 

Minor side effects include drowsiness confusion, gastrointestinal upset, gynaecomastia and menstrual irregularities. 

Side effects include galactorrhoea, skin rash and gynaecomastia. 

On prolonged use leads to tardive dyskinesia in elderly, gynaecomastia, galactorrhoea and parkinsonism. 

Adverse effects include menstrual irregularities, deepening of voice in women, edema, cholestatic jaundice, virilization, priapism, increased libido, acne, precocious puberty, premature epiphyseal closure, gynaecomastia and hepatic carcinoma and reduction in spermatogenesis. 

It is used in menorrhagia, gynaecomastia, fibrocystic breast disease, treatment of visually proven endometriosis or symptomatic control when surgery is contraindicated. It is also used in infertility in women and precocious puberty in boys. 

Adverse effects include, thrombocytopenia, amenorrhoea, azoospermia, skin pigmentation, nausea, vomiting, cataract, gynaecomastia, pulmonary fibrosis and hyperuricaemia. 

Adverse effects include nephrotoxicity, hypertension, tremor, seizures, increased incidence of infections, gingival hyperplasia, hirsutism, flushing, paraesthesias, tinnitus, headache, gynaecomastia and conjunctivitis. It has no toxic effects on bone marrow and RE system. 

Wade MS, Sinclair RD. Reversible painful gynaecomastia induced by low dose finasteride (1 mg/day). Australas J Dermatol 2000 41 55. 

Chianakwalam C.I, McCahy P, Griffiths N.J. A case of male breast cancer in association with bicalutamide-induced gynaecomastia. Breast 2(X)5 14 163—4. 

Nakamura Y, Yoshimoto K, Saima S. Gynaecomastia induced by angiotensin converting enzyme inhibitor. BMJ 1990 300(6723) 541. 

Bergman D, Futterweit W, Segal R, Sirota D. Increased oestradiol in diazepam-related gynaecomastia. Lancet 1981 2(8257) 1225-6. 

Donovan B, Bodsworth NJ, Mulhall BP, Allen D. Gynaecomastia associated with saquinavir therapy. Int J STD AIDS 1999 10(l) 49-50. 

Although cimetidine was very effective for symptomatic treatment and permitted ulcers to heal, there were some side effects associated with its use, albeit at a very low level. In particular, there was a low incidence of gynaecomastia in men this was believed to be due to an anti-androgen effect of cimetidine seen at high doses. 

The aim is to remove the fluid gradually with a maximum weight loss of 0.5 kg/day in the absence of peripheral oedema, or 1.0 kg/day if peripheral oedema is present. Too rapid a diuresis will result in intravascular fluid loss rather than the peripheral oedema. The diuretic should be stopped if the serum sodium falls below 120 mmol/L or if there is a rising serum creatinine. Urinary electrolytes should be monitored to ensure that the spironolactone therapy is effective. The aim is to reverse the sodium/potassium ratio in the urine so that more sodium than potassium is excreted. Most frequent side-effects of spironolactone are those related to its anti-androgenic activity, such as decreased libido, impotence and gynaecomastia in men and menstrual irregularities in women. Other side-effects include hyperkalaemia, uraemia, hyponatraemia and nausea. 

Boulenger A, Viseux V, Plantin-Eon I, Commegeille P, Plantin P. Gynaecomastia following treatment by fluoxetine. J Eur Acad Dermatol Venereol 2003 17 97-116. 

Gynaecomastia, unless related to spironolactone use, indicates that the liver s metabolising capacity is reduced as it is unable to metabolise oestrogens. 

Metoclopramide, domperidone and prochlorperazine can increase serum prolactin levels, leading to galactorrhoea, irregular periods and gynaecomastia. Raised plasma aldosterone levels have been reported with metoclopramide in both healthy individuals and cirrhotic patients with ascites. 

OESTROGENS 1. ANTICANCER AND IMMUNOMODULATING DRUGS - cidosporin, tacrolimus 2. CALCIUM CHANNEL BLOCKERS-nicardipine, nisoldipine, verapamil 3. DIURETICS-spironolactone Risk of gynaecomastia Inhibition of 2-hydroxylation or 17-oxidation of oestradiol in the liver, causing T oestradiol pool in the body Watch for gynaecomastia and warn patients... 

Adverse reactions include nausea, giddiness, headache, pruritus and photophobia. Impairment of testosterone synthesis may cause gynaecomastia and decreased libido in men. Of particular concern is impairment of liver function, ranging from transient elevation of hepatic transaminases and alkaline phosphatase to severe injury and death. 

The RALES trial randomised 1663 patients with stable heart failure to either placebo or spironolactone (New England Journal of Medicine 1999 341 709). All patients were maintained on their optimised therapy that included ACE inhibitors. After 2 years of follow-up the trial was terminated prematurely due to a 30% reduction of mortality in the spironolactone treated patients both progressive pump failure and sudden death were significanly reduced. Gynaecomastia or breast discomfort occurred in 10% of treated patients (1% in controls), but significant h) erkalemia occurred in surprisingly few patients. RALES was not adequately powered to decide whether the action of spironolactone is additive to that of a p-blocker. 

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