Unilateral Gynecomastia: Spironolactone

Background and Aim: Gynaecomastia enlargement of breast in males; due to hyperplasia the glandular tissue. Causes: Physiological (20%) Pathological (30%) Drugs (10-20%) Idiopathic (25%) (2) Although Gynecomastia spirolonactone is bilateral, we report a case unilateral gynecomastia; previously similar has been reported. Case Report: A 58 yrs male, kc Chronic liver disease (NASH) with ascites, controlled on diuretics (spironolactone 50mg furosemide 20mg), for last 8 months; presented painful swelling right breast, 10 days; On examination, firm, mobile lump was palpated beneath nipple. Right normal; Blood tests: HB 9.0; TLC 5,600 Platelets 90,000; Bilirubin 2.1; Albumin 3.0; SGOT/PT/ALP: 98/34/119; AFP: Urea / creatinine: 36/0.9 Probable cause attributed spironolactone drug stopped; patients’ pain started improve returned normal after 1 month stopping. many mechanisms: blockage androgen receptors, prevent binding testosterone & dihydrotestosterone; decrease production from testes by inhibiting 17± hydroxylase 17, 20 desmolase; increase estrogen enhancing peripheral conversion estradiol. Conclusion: Spironolactone known bilateral few reports are available cases; It important clinician keep this fact mind, take proper history, examination stop offending drug, which would suffice most cases.