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Costanzo P.R.,Servicio de Endocrinologia | Suarez S.,Servicio de Endocrinologia | Aszpis S.M.,Hospital Durand | Stewart Usher J.G.,Centro Medico Haedo | And 5 more authors.
Revista Argentina de Endocrinologia y Metabolismo | Year: 2015

Gynecomastia is a benign enlargement of breast tissue in men. It occurs physiologically in three stages of life: newborns, pubescent boys and older adults. It is a frequent reason for consulting and -though generally benign-it produces anxiety and discomfort. It is important to differentiate between the asymptomatic presence of palpable breast tissue, which is of little clinical relevance, and a recent onset breast enlargement usually associated with pain and swelling, which can be a sign of illness or pharmacological impact. Aims: To evaluate the presenting features (symptoms, duration, laterality, etc.) and biochemical profile of gynecomastia; to assess the etiology of gynecomastia in the study population. Methods: Retrospective, multicenter study. We evaluated the medical records of 220 men aged 18-85 years (average age 33 years: median 39.5 ± 19.6 years) with imaging and clinical diagnosis of gynecomastia who had undergone biochemical assessment. The consultation period was from May 2002 to June 2013. The following data was assessed: breast pain, duration of gynecomastia, sexual function, galactorrhea, weight change, habits (alcohol, drug addiction, anabolic steroids), history of pubertal gynecomastia, use of medication and family history of gynecomastia. Physical examination: weight, height, body mass index (BMI), breast and gonadal examination. Laboratory: total testosterone (TT), bioavailable testosterone (Bio-T), estradiol (E2), luteinizing hormone, follicle stimulating hormone, prolactin, thyrotropin, alpha fetoprotein, β subunit of human chorionic gonadotropin and carcinoembryonic antigen. For hormonal abnormalities, each site's reference values were considered. In all patients, gynecomastia was confirmed by ultrasound and/or mammography. Results: A higher prevalence of gynecomastia is observed in the age range between 21 and 30 years (n = 66; 30 %). Most patients presented spontaneously (77.7 %); the rest were referred from other specialties. The most frequent reasons for consultation were aesthetic reasons (70.4 %) and breast pain (27.3 %). Twenty-three point two percent of subjects had a history of pubertal gynecomastia. Evolution time prior to consultation was highly variable (1 month to 40 years). On physical examination, 122 patients (55.4 %) had bilateral and 98 patients (44.6 %) had unilateral gynecomastia (54.1 % left and 45.9 % right); 44.8 % were overweight and 22.4 % were obese. BMI: 27.2 ± 4.3 kg/m2. In 29.1 % of patients breast pain was identified on medical examination. One patient (with macroprolactinoma) had spontaneous galactorrhea and in 3 patients mammary secretion was found on physical examination. Gonadal examination was performed in 147 patients, 126 had normal testicular volume, 10 had bilateral hypotrophy, 7 had unilateral hypotrophy and 4 unilateral absence of the testis. Idiopathic gynecomastia was the most common etiology (47.8 %). The most relevant secondary cause of gynecomastia was anabolic steroids consumption (14.1 %). In 6 cases two causes coexisted (total: 226 causes). Elevated cancer markers were not found in any of the cases. If we divide the population into patients younger and older than 40, in the former the most common secondary causes were the use of anabolic steroids and persistent pubertal gynecomastia, while in patients older than 40, they were hypogonadism and medical drug use. Patients with bilateral gynecomastia had a longer history of gynecomastia: 3.4 ± 5.7 versus 1.4 ± 1.9 years (p = 0.0004); higher BMI: 28.4 ± 4.4 versus 25.5 ± 3.5 kg/m2 (p < 0.0001) and lower TT levels: 4.7 ± 2.0 versus 5.4 ± 1.9 ng/ml (p=0.019) than patients with unilateral gynecomastia, respectively. A negative correlation between BMI and TT was found (r= -0.38, p< 0.0001). No correlation between BMI and E2 and between BMI and bio-T was found. Ultrasound was used in 83.2 % of patients and mammography in 43.6 % (both 28.2 %). Conclusions: Patients with gynecomastia consulted more often for aesthetic reasons and secondarily for breast pain. Detection of galactorrhea was rare. Gonadal examination was normal in most patients and 66.7 % were overweight or obese. Just over half of the patients presented with bilateral gynecomastia and compared with cases of unilateral gynecomastia, they had a longer history of disease, higher BMI and lower TT levels. The most common cause of gynecomastia was idiopathic in all age groups. Persistent pubertal gynecomastia and anabolic steroids consumption were frequent in patients younger than 40 years, and medical drug use and hypogonadism in patients over 40. The presence of gynecomastia may be the expression of an underlying and clinically relevant disease. This highlights the need for an adequate and complete clinical, biochemical and imaging assessment in these patients. Copyright ® 2015 por la Sociedad Argentina de Endocrinología y Metabolismo. Source

Gagliardino J.J.,National University of La Plata | Gil J.E.C.,National University of La Plata | Faingold M.C.,Servicio de Endocrinologia y Metabolismo | Litwak L.,Servicio de Endocrinologia
Medicina (Argentina) | Year: 2013

As in the rest of the world, there is a significant gap between scientific knowledge regarding diabetes mellitus and the daily practice outcome, in Argentina. Inadequate diabetes control combined with associated cardiovascular risk factors are responsible for an elevated morbid-mortality incidence and the consequent raise in the socioeconomic burden. Some of the factors leading to this situation are the late diagnosis of the disease, the clinical "inertia" (reluctance to prescribe insulin) and the poor education given to the health care team as well as the persons with diabetes. The implementation of a national diabetologic education program targeting health care providers, the persons with diabetes and their families, could contribute to optimize the appropriate insulin prescription, and consequently improve their life quality, while reducing the disease socioeconomic burden. In order to optimize the education program's strategy outcome, insulinization cabinets should be incorporated, the participation of all health systems (public health, social security and private health insurance companies), the media, health sciences, schools and the pharmaceutical industry are needed. Source

Commendatore V.,Servicio de Endocrinologia Diabetes y Nutricion | Dieuzeide G.,Servicio de Endocrinologia y Metabolismo | Faingold C.,Servicio de Endocrinologia y Metabolismo | Lujan D.,Asociacion Colombiana de Diabetes | And 5 more authors.
International Journal of Clinical Practice | Year: 2013

Aims: To implement a patient registry and collect data related to the care provided to people with type 2 diabetes in six specialized centers of three Latin American countries, measure the quality of such care using a standardized form (QUALIDIAB) that collects information on different quality of care indicators, and analyze the potential of collecting this information for improving quality of care and conducting clinical research. Methods: We collected data on clinical, metabolic and therapeutic indicators, micro- and macrovascular complications, rate of use of diagnostic and therapeutic elements and hospitalization of patients with type 2 diabetes in six diabetes centers, four in Argentina and one each in Colombia and Peru. Results: We analyzed 1157 records from patients with type 2 diabetes (Argentina, 668; Colombia, 220; Peru, 269); 39 records were discarded because of data entry errors or inconsistencies. The data demonstrated frequency performance deficiencies in several procedures, including foot and ocular fundus examination and various cardiovascular screening tests. In contrast, HbA1c and cardiovascular risk factor assessments were performed with a greater frequency than recommended by international guidelines. Management of insulin therapy was sub-optimal, and deficiencies were also noted among diabetes education indicators. Conclusions: Patient registry was successfully implemented in these clinics following an interactive educational program. The data obtained provide useful information as to deficiencies in care and may be used to guide quality of care improvement efforts. © 2013 John Wiley & Sons Ltd. Source

Pacenza N.,Servicio de Endocrinologia y Metabolismo | Pasqualini T.,Seccion Endocrinologia | Gottlieb S.,CONICET | Knoblovits P.,Servicio de Endocrinologia | And 5 more authors.
International Journal of Endocrinology | Year: 2012

The aim of the study was to establish the characteristics of presentation of 94 patients with Kinelfelter's syndrome (KS) referred to the endocrinologist at different ages. The diagnosis of KS was more frequent in the age group between 11 and 20 years (46.8). Most of the patients (83.7) showed the classic 47,XXY karyotype and 7.1 showed a 47,XXY/46,XY mosaicism. Half of the patients younger than 18 years presented mild neurodevelopmental disorders. The most frequent clinical findings were cryptorchidism in prepubertal patients, and small testes, cryptorchidism, and gynecomastia in pubertal patients. FSH, LH, AMH, and inhibin B levels were normal in prepubertal patients and became abnormal from midpuberty. Most adults were referred for small testes, infertility, and gynecomastia; 43.6 had sexual dysfunction. Testosterone levels were low in 45. Mean stature was above the 50th percentile, and 62.5 had BMI 25.0kg/m2. In conclusion, the diagnosis of Klinefelter syndrome seems to be made earlier nowadays probably because pediatricians are more aware that boys and adolescents with neuro-developmental disorders and cryptorchidism are at increased risk. The increasing use of prenatal diagnosis has also decreased the mean age at diagnosis and allowed to get insight into the evolution of previously undiagnosed cases, which probably represent the mildest forms. In adults average height and weight are slightly higher than those in the normal population. Bone mineral density is mildly affected, more at the spine than at the femoral neck level, in less than half of cases. Copyright © 2012 Néstor Pacenza et al. Source

Pacenza N.,Servicio de Endocrinologia y Metabolismo | Pasqualini T.,Seccion Endocrinologia | Gottlieb S.,CONICET | Knoblovits P.,Servicio de Endocrinologia | And 5 more authors.
Revista Argentina de Endocrinologia y Metabolismo | Year: 2010

Klinefelter syndrome (KS) is the most common chromosomal aberration among men, with an estimated prevalence of 1:600 newborns. It is an X chromosome polysomy, with X disomy being the most common variant (47,XXY). The aim of this study was to establish the characteristics of KS presentation at different ages, including signs and symptoms, laboratory parameters and other diagnostic tests. The diagnosis of KS was more frequent in the age group between 11 and 20 years (46.8%). Most of the patients (83.7%) showed the classic 47,XXY karyotype and 7.1% showed a 47,XXY/46,XY mosaicism. While mean prepubertal height was not different from the control population, it was significantly higher at puberty. Patients consulted most frequently for small testes, infertility and cryptorchidism. In four cases the diagnosis was prenatal. 50% of our patients younger than 18 years presented neurocognitive disorders. The more frequent clinical findings were cryptorchidism in prepubertal patients; small testes, cryptorchidism and gynecomastia in pubertal patients. All our patients in Tanner stage III or more presented small testes. FSH and LH levels were normal in prepubertal patients and increased abnormally at puberty. On the other hand, most adults consulted for small testes, infertility and gynecomastia. 43.6% of patients had decreased libido, sexual and/or ejaculatory dysfunction. In adults average height (178.8 ± 9.0 cm) and weight (83.6 ± 21.0 kg), were higher than in the normal population, however 8 patients (19%) had a height less tan 170 cm. There was 62.5% of overweight / obesity (BMI ≥ 25.0 kg/m 2) in the whole group of adult patients. 35.2% had eunuchoid proportions. All patients had testicular hypotrophc, with a median testicular volume of 3.5 ml (range 1-8 ml). Total testosterone (TT) levels were normal in 45% of adult patients, showing significant correlation with age. All patients aged 40 or more years had subnormal TT levels. In patients who underwent semen analysis, severe oligospermia and azoospermia were found in 10.7% and 89.3% respectively. Bone mineral densitometry showed low bone mass in 46.4% of cases. No significant differences in the prevalence of osteopenia and osteoporosis were observed among patients with normal or subnormal TT. Copyright 2010 por la Sociedad Argentina de Endocrinología y Metabolismo. Source

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