A Thread Devoted To Gynecomastia

[Michael Scally MD]

J&J Hit With $8 Billion Jury Award Over Antipsychotic Drug [Gynecomastia]
J&J Hit With $8 Billion Jury Award Over Antipsychotic Drug

A Philadelphia jury on Tuesday ordered Johnson & Johnson JNJ -0.99% to pay $8 billion in damages to a Maryland man who said his use of J&J’s antipsychotic Risperdal as a child caused enlarged breasts and the company failed to properly warn of this risk.

It was the biggest award to date among more than 13,000 lawsuits against J&J alleging that Risperdal caused a condition called gynecomastia in boys, which involves enlargement of breast tissue. The lawsuits generally claim that J&J was aware of the risk of this side effect, but understated the risk to doctors.

The latest verdict stems from a lawsuit filed by Nicholas Murray, who said his use of Risperdal between 2003 and 2008 caused gynecomastia. In 2015, a Philadelphia jury awarded Mr. Murray $1.75 million in damages, which a judge reduced to $680,000, but the judge had barred the jury from awarding punitive damages at that time.

An appeals court later overturned the judge’s decision on punitive damages, clearing the way for the punitive-damages phase of the trial to start in September, ending with Tuesday’s verdict.

US Jury Orders Johnson & Johnson To Pay $8bn To Man With Gynaecomastia Linked To Risperidone

Johnson & Johnson and its subsidiary Janssen Pharmaceuticals have been ordered by a Philadelphia jury to pay $8bn (£6.5bn; €7.3bn) in punitive damages to Nicholas Murray, 26, who developed gynaecomastia while taking the atypical antipsychotic drug risperidone.

Risperidone (marketed in the US by Janssen as Risperdal) can increase concentrations of the hormone prolactin, causing breast development in boys and men.

Two different paediatricians prescribed the drug to Murray off label. He began taking it in 2003 when he was aged 9 for sleep disturbances associated with an autism spectrum disorder. He stopped five years later when the family became concerned about his developing breasts.

In 2013, aged 20, Murray sued Janssen, alleging that the company downplayed the risk of gynecomastia in its marketing to doctors and its application …

Dyer O. US jury orders Johnson & Johnson to pay $8bn to man with gynaecomastia linked to risperidone. BMJ (Clinical research ed) 2019;367:l5990. http://www.bmj.com/content/367/bmj.l5990.abstract

 

[Michael Scally MD]

Gynaecomastia Caused by A Feminising Adrenal Tumour

Gynaecomastia is a common finding which typically appears during puberty in boys and in elderly males. At these times, gynaecomastia is likely to be due to physiological hormonal fluctuations although there are a number of other causes including medications which must also be considered.

We present a case of a 52 year old male with gynaecomastia, hypogonadotropic hypogonadism and hyperoestrogenaemia. MRI of the adrenals confirmed the presence of an adrenocortical carcinoma, which after pre-operative hormone workup was diagnosed as a feminising adrenal tumour. The lesion was excised and adjunct Mitotane therapy commenced.

Hyperoestrogenaemia is often secondary to exogenous testosterone administration; however, in the presence of hypogonadotropic hypogonadism other sources of oestrogen should be sought.

This case highlights a rare, but nonetheless important cause of gynaecomastia.

Gibbons SM, Jassam N, Abbas A, Stuart K, Fairhurst A, Barth JH. ANNALS EXPRESS: Gynaecomastia caused by a feminising adrenal tumour. Annals of clinical biochemistry 2019:0004563219884960. SAGE Journals: Your gateway to world-class research journals

 

[Michael Scally MD]

[OA] Causes and Metabolic Consequences of Gynecomastia

Background: Gynecomastia (GM) is a benign enlargement of male breast due to glandular tissue proliferation. GM is a symptom of systemic or local hormonal disturbances, which could be associated with functional changes or pathological conditions. However, the long-lasting steroid imbalance in men with GM might exert negative influence on their metabolic health.

Methods: A total of 110 adult men with symptomatic GM were included in the present retrospective cross-sectional study. Anthropometric, metabolic, and hormonal data of the patients were collected.

Results: In almost 64% of GM patients, the underlying pathological condition was identified. Moreover, the development of GM was among the primary symptoms leading to the proper diagnosis in more than 40% of hypogonadal patients.

The prevalence of metabolic syndrome (MS) was 53%; the highest prevalence of MS was found in patients with medication-induced GM and in the hypogonadal patients, whereas the lowest prevalence was observed in men with idiopathic postpubertal GM despite the similar degree of obesity. The lower testosterone levels were associated with more unfavorable lipid profile in the GM patients.

Conclusion: The development of GM in adults might be an important symptom of an underlying gonadal disease. Moreover, it could be associated with an increased risk of metabolic disturbances.

Our results support the need of detailed laboratory and hormonal investigations in patients with GM including targeted screening for metabolic disturbances.

Further longitudinal studies are needed to evaluate the long-term consequences of sex hormones imbalance on cardiovascular morbidity and mortality in adults with GM.

Robeva R, Elenkova A, Zacharieva S. Causes and Metabolic Consequences of Gynecomastia in Adult Patients. Int J Endocrinol 2019;2019:6718761. https://www.hindawi.com/journals/ije/2019/6718761/

 

[SaneDog]

Cool thread, great read. There's a lot of information here.

 

[Michael Scally MD]

Marked Increase in Incident Gynecomastia: A 20-year National Registry Study 1998-2017

Context: Gynecomastia, the proliferation of mammary glandular tissue in the male, is a frequent but little studied condition. Available prevalence data are based on selected patient populations or autopsy cases with their inherent bias.

Objective: To evaluate the age-related incidence and secular trends in gynecomastia in the general population.

Design: Observational, 20-year national registry study.

Setting: Population-based study using nationwide registry data.

Participants: All Danish males (0-80 years) with a first-time diagnosis of gynecomastia.

Interventions: NA.

Main outcome measures: All Danish males (0-80 years) were followed-up for incident diagnosis of gynecomastia in the Danish National Patient Registry from 1998-2017 using International Codes of Diseases, ICD-10 and the Danish Health Care Classification System. Age specific incidence rates were estimated. The hypothesis tested in this study was formulated prior to data collection.

Results: Overall a total 17,601 males (0-80 years) were registered with an incident diagnosis of gynecomastia within the 20-year study period, corresponding to 880 new cases per year and an average 20-year incidence of 3.4 per 10,000 men (0-80 years). The average annual incidence was 6.5/10,000 in post-pubertal males age 16-20 years and 4.6/10,000 in males age 61-80 years, with a respective 5 and 11-fold overall increase in these two age-groups over the 20-year period.

Conclusions: The incidence of gynecomastia has dramatically increased over the last 20 years implying that the endogenous or exogenous sex steroid environment has changed, which is associated with other adverse health consequences in men such as an increased risk of prostate cancer, metabolic syndrome, diabetes type 2 or cardiovascular disorders.

Koch T, Bräuner EV, Busch AS, Hickey M, Juul A. Marked Increase in Incident Gynecomastia: A 20-year National Registry Study 1998-2017 [published online ahead of print, 2020 Jul 7]. J Clin Endocrinol Metab. 2020;dgaa440. doi:10.1210/clinem/dgaa440 Marked Increase in Incident Gynecomastia: A 20-year National Registry Study 1998-2017

 

[Michael Scally MD]

Holzmer SW, Lewis PG, Landau MJ, Hill ME. Surgical Management of Gynecomastia: A Comprehensive Review of the Literature. Plast Reconstr Surg Glob Open. 2020 Oct 29;8(10):e3161. doi: 10.1097/GOX.0000000000003161. PMID: 33173677; PMCID: PMC7647635. Surgical Management of Gynecomastia: A Comprehensive Review of the Literature

Gynecomastia is a graded condition characterized by enlargement of the male breast that affects a significant proportion of the male population. A plethora of varying surgical approaches currently exists in the literature; thus this comprehensive review sought to analyze surgical practice patterns and trends as they pertain to gynecomastia grade and severity.

The current literature was queried utilizing the PubMed and MEDLINE databases-based on predefined parameters and individual review, 17 studies were ultimately included. Key data points included gynecomastia grade, surgical intervention, rate of complication, including hematoma, seroma, infection, and necrosis, and drain use.

Two-sample t test was utilized for further analysis. A total of 1112 patients underwent surgical treatment for gynecomastia. Skin-sparing mastectomy with or without liposuction was the most frequently used procedure followed by mastectomy with skin reduction.

Major complication rates ranged from 0% to 33%, with hematoma formation being most common (5.8%) followed seroma (2.4%). There was a higher rate of hematoma/seroma formation among authors who routinely utilized drain placement (9.78% versus 8.36%; P = 0.0051); however, this is likely attributable to the large discrepancy in percentage of grade III patients found in each group (50.23% versus 4.36%; P = 0.0000).

As a wide variety of surgical techniques exist for the treatment of gynecomastia, an individualized approach based upon gynecomastia grade and patient preference may assist the surgeon in providing optimal outcomes. This senior author's preferred method for treatment of gynecomastia is illustrated in the included algorithm.

 

[Michael Scally MD]

Epidemiology of Male Breast Diseases

Highlights

Male patients form a significantly smaller subset of patients referred to breast imaging centers.

The vast majority of male breast diseases are benign, the most common being gynecomastia.

Male patients with average risk for breast cancer do not require routine breast screening.

Male patients are less likely to seek medical help for breast-related symptoms due to cultural and social barriers. Understanding men's perception and providing gender-specific, targeted patient education can help breach these barriers.


Objective: To review breast imaging utilization and epidemiology of breast diseases in male patients referred to our breast center.

Material and methods: A retrospective analysis of all male patients who underwent breast imaging at our institution over a 10 year period (03/14/2008 to 03/13/2018) was performed. Patient history, imaging findings, biopsy reports, surgical interventions and follow-up data were reviewed.

Results: Over the 10 year period, 143 male patients (0.1% of referred breast center patients) underwent breast imaging (versus 139,134 female patients). Mean age was 57.4 years (SD 19.7, median 59, range 21-92 years). The most common indication for referral was a palpable breast mass (98%). The most common diagnosis was gynecomastia (72%). Of the 20 (14%) patients who underwent core biopsy; 1 (0.7%) had breast cancer and the remaining 19 had benign pathologies. Follow-up imaging was recommended for 22 (15.4%) patients, of whom 15 (68%) were lost to follow-up. Two patients under the age of 25 years inadvertently underwent initial mammography instead of ultrasound.

Conclusion: The epidemiology of breast diseases in our male patient population mirrors that of the general male population worldwide; with an overwhelming 99.3% cases falling into benign category. Two-thirds of our male patients for whom short interval follow up was recommended were lost to follow-up, signifying the need for a more proactive approach in ensuring their compliance. It is important to increase awareness among referring clinicians and general radiologists regarding male breast imaging recommendations so that the appropriate imaging study is performed.

Swamy N, Rohilla M, Raichandani S, Bryant-Smith G. Epidemiology of male breast diseases: A 10-year institutional review. Clin Imaging. 2020 Nov 16;72:142-150. doi: 10.1016/j.clinimag.2020.11.027. Epub ahead of print. PMID: 33249401. https://www.clinicalimaging.org/article/S0899-7071(20)30455-1/fulltext

 

[MFAAS]

Wow, some a excellent articles here! H-o-l-y shit...the one where the guy got $8B from JnJ is insane!! I had childhood gyno too... where's my payout? I don't need 8 bill...hell I'll take a cool 5 milly LOL

The article saying gyno has increased over recent decades is interesting too. I am not surprised at all. I'm convinced (even moreso after having lengthy discussions with an ecology-professor who is one of the leading researchers in this field in the US) that it is due to all the endocrine disrupting chemicals (EDCs) in the environment nowadays, paired with modern life. The plastics EVERYWHERE, the pharmaceuticals, the pesticides and herbicides getting sprayed into the air everywhere and all over our food. Also, if the kids aren't on some pharmaceutical drugs then they are consuming active metabolites in the water. Also I wonder if the strength of the weed nowadays isn't affecting it too (not that weed causes gyno, but that it disrupts the endocrine system). Not to mention the terrible diet of 90% of people and their kids too.

I had childhood gyno, didn't know what it was until I was 24. I was always self conscious about my chest since I was like 13 (I was kinda chubby too until I hit 17 or 18). I really wish I would've gotten a hormone panel as a teen--just to know where I was at. I would guess high E2, which wouldn't have helped my anxiety or depression either lol. All those years popping pills and all I needed was an AI!! /s?

I got my gyno removed 2 years ago from a doc in Chicago, Dr Adajar. He did an amazing job. Full gland removal and laipo. Living the blast and cruise life and not having to worry about gyno is super nice. You'd have to really fuck up BAD for a loong time to make it grow back--and even then if would take so long you would have a million opportunities to zap it and make it stop. Cant recommend him enough for anyone looking for a good doc in the US. Worth every penny and the travel time!!

 

[Michael Scally MD]

[OA] It's Not Always Gynecomastia: A Case of Diffuse Large B-Cell Lymphoma Presenting as Breast Mass in a Male Patient

We report a case of diffuse large B-cell breast lymphoma that presented as a palpable breast lump in a male patient evaluated with digital mammography and targeted breast ultrasound (US) but ultimately confirmed by US-guided core needle biopsy.

We will discuss the appropriate workup algorithm for a palpable breast lump in a male patient as outlined by the American College of Radiology (ACR) Appropriateness Criteria. While gynecomastia is the most common reason for a new palpable breast lump in a male patient, male breast cancer (including lymphoma and metastasis) can have a similar appearance on imaging.

Our goal is to provide clarity on proper radiographic assessment protocols and imaging features of palpable breast masses in men by emphasizing the role of anatomical location and symmetry in distinguishing it from more common causes, such as gynecomastia, in future diagnostic imaging scenarios.

Leon A, Way AR, Sharma S, Letter H. It's Not Always Gynecomastia: A Case of Diffuse Large B-Cell Lymphoma Presenting as Breast Mass in a Male Patient. Cureus. 2021 Jan 27;13(1):e12944. doi: 10.7759/cureus.12944. PMID: 33654621; PMCID: PMC7910194. https://www.cureus.com/articles/49138-its-not-always-gynecomastia-a-case-of-diffuse-large-b-cell-lymphoma-presenting-as-breast-mass-in-a-male-patient

 

[Thatbish]

Wow, some a excellent articles here! H-o-l-y shit...the one where the guy got $8B from JnJ is insane!! I had childhood gyno too... where's my payout? I don't need 8 bill...hell I'll take a cool 5 milly LOL

The article saying gyno has increased over recent decades is interesting too. I am not surprised at all. I'm convinced (even moreso after having lengthy discussions with an ecology-professor who is one of the leading researchers in this field in the US) that it is due to all the endocrine disrupting chemicals (EDCs) in the environment nowadays, paired with modern life. The plastics EVERYWHERE, the pharmaceuticals, the pesticides and herbicides getting sprayed into the air everywhere and all over our food. Also, if the kids aren't on some pharmaceutical drugs then they are consuming active metabolites in the water. Also I wonder if the strength of the weed nowadays isn't affecting it too (not that weed causes gyno, but that it disrupts the endocrine system). Not to mention the terrible diet of 90% of people and their kids too.

I had childhood gyno, didn't know what it was until I was 24. I was always self conscious about my chest since I was like 13 (I was kinda chubby too until I hit 17 or 18). I really wish I would've gotten a hormone panel as a teen--just to know where I was at. I would guess high E2, which wouldn't have helped my anxiety or depression either lol. All those years popping pills and all I needed was an AI!! /s?

I got my gyno removed 2 years ago from a doc in Chicago, Dr Adajar. He did an amazing job. Full gland removal and laipo. Living the blast and cruise life and not having to worry about gyno is super nice. You'd have to really fuck up BAD for a loong time to make it grow back--and even then if would take so long you would have a million opportunities to zap it and make it stop. Cant recommend him enough for anyone looking for a good doc in the US. Worth every penny and the travel time!!

He just moved his practice to Florida actually. I was checking it out because I’m in the area. How much did yours cost roughly? If you don’t mind me asking.

 

[MFAAS]

He just moved his practice to Florida actually. I was checking it out because I’m in the area. How much did yours cost roughly? If you don’t mind me asking.

Mine was $4500 for full gland removal and lipo. That was with a discount code though that they graciously decided to accept after expiration, standard price now at the clinic is 5500 I think.

 

[Thatbish]

Dang! I’ve heard some guys getting it done for only 2 grand. I’m guessing that’s without both gland removal and lipo though. I have the money but I just don’t know if it’s really worth it for me yet because I don’t have really bad gyno yet

 

[MFAAS]

Dang! I’ve heard some guys getting it done for only 2 grand. I’m guessing that’s without both gland removal and lipo though. I have the money but I just don’t know if it’s really worth it for me yet because I don’t have really bad gyno yet

Well it all depends on the doctor. Some guys will even fly to India or Mexico/somewhere where they'll do it for like 1 grand. Personally, I am not trying to do that lol, I want to be in the US, with a top-notch US surgeon. We have all seen the results of bad plastic surgery, although usually with womens butts/boobs/faces (seriously, what the fuck are these bitches thinking nowadays?!). If you google gyno surgery gone wrong or anything similar you'll see what happens when someone fucks up. NOT a risk I am willing to take. Then you need to shell out ANOTHER several thousand dollars to a different surgeon to fix what the last surgeon did wrong.

Choose your surgeon wisely.