(P06) Evaluation of Male Gynecomastia in a Geriatric Patient

Introduction: Gynecomastia a disorder caused by proliferation of male breast glandular tissue, usually presents as bilateral asymmetrical or unilateral findings. Gynecomastia may occur when an imbalance of estrogen or estrogen serum levels or precursors (e.g., human chorionic gonadotropin [hCG]) are elevated. However, patients may present with pseudogynecomastia, an accumulation of subareolar fat without proliferation of glandular tissue. Gynecomastia commonly asymptomatic and can be seen in neonatal, pubertal, and elderly males. The prevalence of asymptomatic gynecomastia is 70% in males age 50-69 years old. The diagnostic process include initial history, examination, mammography, and possible medications associated with gynecomastia should be utilized to differentiate between true gynecomastia and a mass which require further evaluation. A interdisciplinary team approach is crucial to ensure comprehensive assessment and evaluation possible causes of gynecomastia.

Case Description : 82-year-old male with a medical history of chronic kidney disease, hypertension, chronic obstructive lung disease, benign adenoma of prostate and opioid use disorder. Concerns for gynecomastia due to daily breast tenderness with notable pain while dressing. The Geriatric Primary Care Provider (PCP) completed an extensive history and examination, including a mammogram to assess for possible malignancy. Mammogram results: Subareolar density consistent with gynecomastia in both breasts appear benign.

The patient was referred to the Clinical Pharmacist Practitioner (CPP) for evaluation of medications which may have been contributing to gynecomastia. A thorough evaluation of the patient’s medications, antihypertensive agents' hydrochlorothiazide (HCTZ) and amlodipine were identified as possible contributors of gynecomastia. FDA Adverse Events Reporting System (FAERS) revealed HCTZ had 30 patients during 1973-2021 and amlodipine had 47 patients during 1999-2024 with this adverse event.

An interdisciplinary treatment approach was utilized by the CPP and PCP. Both HCTZ and amlodipine were discontinued. Hydralazine was initiated for hypertensive therapy. Close monitoring was conducted by the CPP and symptoms resolved after 4 weeks. The patient has been followed for almost 1 year and remains symptom free.

Discussion: Gynecomastia although not common and often asymptomatic, can have a detrimental impact on patients' quality of life. An interdisciplinary treatment approach such as thorough review medical history, physical examination and medication evaluation is crucial to ensure appropriate medical interventions. In various clinical settings, e.g. geriatric primary care, the interdisciplinary team is vital to ensure optimal patient care and improved quality of life. This case study adds to current literature by demonstrating potential association between uncommon medications such as HCTZ and amlodipine and gynecomastia in older patients which will heighten clinical awareness when prescribing these medications.