유방비대/여성형 유방(Gynecomastia)

유방비대/여성형 유방: 원인 및 감별진단

대부분 원인을 정확히 찾을 수 없습니다.

생리적/특발성 원인	vs.	병적 원인
Neonatal/infancy Pubertal Middle or advanced age		약물 Primary testosterone deficiency (특히, Klinefelter syndrome) Secondary testosterone deficiency Hyperthyroidism Neoplasms Testicular: originating from germ (secreting forms), Leydig or Sertoli cells Adrenal: androgen- or estrogen-secreting tumors Ectopic production of hCG Hepatic causes, malnutrition Renal causes Rare causes Enzymatic defects of testosterone production Androgen insensitivity syndromes True hermaphroditism Excessive extra-glandular aromatase activity Environmental polluting substances

hCG, human chorionic gonadotropin; T, testosterone.

영아의 60-90%에서 발생
모체-태반-태아단위로부터 에스트로겐 자극으로 인한 일시적인 유방팽대 → 에스트로겐이 신생아 혈류에서 소멸되면 유방성장이 멈추고 2-3주 안에 유방조직이 점차 퇴화

호르몬

항안드로겐/안드로겐 합성억제

Bicalutamide, flutamide, nilutamide, cyproterone, GRH agonists (leuprolide, goserelin)

항생제

항궤양제

항암제

심혈관약물

Digoxin, ACEIs (예. captopril and enalapril), calcium channel blockers (diltiazem, nifedipine, verapamil), amiodarone, methyldopa, spironolactone, reserpine, Minoxidil

정신작용약물

Anxiolytic agents (예. diazepam), tricyclic antidepressants, phenothiazines, haloperidol, atypical antipsychotic agents

기타

Antiretroviral therapy for HIV, metoclopramide, penicillamine, phenytoin, sulindac, theophylline

gynecomastia 관련 병력
- 발생/지속기간
- 부위: unilateral or bilateral location
- 압통유무
- 이전에도 발생한 적이 있는지 여부
Previous or current cryptorchidism, fertility status
동반증상: testosterone deficiency, hyperthyroidism, systemic illnesses
약물력

여성형유방증	↔	유방암
유두를 중심으로 유륜 하방에 대칭적으로 분포 단단, 압통(+)		비대칭적으로 분포 피부나 근막에 고정, 압통(-)

1차 검사	±	추가검사
LH, FSH, testosterone, E2 (17bestradiol), SHBG β-hCG TSH Prolactin Liver function: AST, ALT, albumin Renal function: creatinine, urea Testicular ultrasound scan		DHEA-S, D4-A Karyotype DNA for genetic analysis(예. PCR for androgen receptor)

D4-A, D4-androstenedione; DHEA-S, dehydroepiandrosterone-sulfate; SHBG, sex hormone-binding globulin

참고자료

[유방비대/여성형 유방: 원인 및 감별진단]

대한외과학회. 외과학 1판(2011). P889-890
Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc 2009;84(11):1010–5.
Braunstein GD. Gynecomastia. N Engl J Med. 2007;357(12):1229-1237.
Dickson G. Gynecomastia. Am Fam Physician 2012;85(7):716–22.
Narula HS, Carlson HE. Gynaecomastia--pathophysiology, diagnosis and treatment. Nat Rev Endocrinol 2014;10(11):684–98.
Kanakis GA, Nordkap L, Bang AK, et al. EAA clinical practice guidelines-gynecomastia evaluation and management. Andrology 2019;7(6):778–93.
Mieritz MG, Christiansen P, Jensen MB, Joensen UN, Nordkap L, Olesen IA, Bang AK, Juul A & Jørgensen N. (2017) Gynaecomastia in 786 adult men: clinical and biochemical findings. Eur J Endocrinol 176, 555–566.
Park IS et al. A Case of Gynecomastia Induced by Use of Doxazosin. Korean J Med 2016;90:239-2

[유방비대/여성형 유방: 진단적 접근]

Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc 2009;84(11):1010–5.
Braunstein GD. Gynecomastia. N Engl J Med. 2007;357(12):1229-1237.
Dickson G. Gynecomastia. Am Fam Physician 2012;85(7):716–22.
Narula HS, Carlson HE. Gynaecomastia--pathophysiology, diagnosis and treatment. Nat Rev Endocrinol 2014;10(11):684–98.
Kanakis GA, Nordkap L, Bang AK, et al. EAA clinical practice guidelines-gynecomastia evaluation and management. Andrology 2019;7(6):778–93.
Mieritz MG, Christiansen P, Jensen MB, Joensen UN, Nordkap L, Olesen IA, Bang AK, Juul A & Jørgensen N. (2017) Gynaecomastia in 786 adult men: clinical and biochemical findings. Eur J Endocrinol 176, 555–566.
Park IS et al. A Case of Gynecomastia Induced by Use of Doxazosin. Korean J Med 2016;90:239-2