Volumen 52 #2 | Año 2015 Volver Indice
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  Clinical features and etiology of gynecomastia in patients at prepubertal age  
  Authors: Gottlieb S, Pasqualini T, Martínez A, Bengolea SV, Azaretzky M, Ciaccio M, Finkielstain GP, Campeni S, Suárez M  
  Gynecomastia is the benign proliferation of male breast glandular tissue. The occurrence of gynecomastia at prepubertal ages is very uncommon and can be a sign of severe endocrine or systemic disease. The main underlying mechanism for the development of gynecomastia appears to be the imbalance between estrogen and androgen action.
Objective: to assess clinical characteristics, etiology and course of prepubertal gynecomastia in a group of patients regularly followed at the endocrinology clinic. We performed a retrospective, descriptive, multicenter study.
Materials and methods: data on family history, past history of the disease, physical examination, and clinical course were collected.
Results: 53 prepubertal patients were included. Median age at presentation was 8.4 years (0.88-13.72 years). An increased prevalence was observed in children > 7 years (79.2 %). Bilateral gynecomastia was the most common form of presentation, (73.5 %). Seventeen patients (32 %) were obese, 7 (13.7 %) with a BMI above 3 SDS. In 34 patients (64.1 %) the etiology of gynecomastia could not be identified (idiopathic). In 12 patients (23.5 %) estrogen exposure was detected; 2 patients suffered from aromatase excess syndrome, 1 had neurofibromatosis type I and optic glioma, 1 had a feminizing adrenocortical tumor and 1 had Peutz-Jeghers syndrome.
Conclusion: Prepubertal gynecomastia is rare. In this cohort of 53 children, the most common etiologies were idiopathic or exogenous estrogens exposure. Although gynecomastia may be due to benign causes, in the majority of patients evaluations should be performed to rule out a severe underlying systemic or endocrine disease.

Rev Argent Endocrinol Metab 52:57-65, 2015
No financial conflicts of interest exist.
  Key words: Gynecomastia, Prepubertal Gynecomastia  
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