Gynecomastia, obesity and underdeveloped testis and penis: suspected hypophysitis successfully cured with low dose of cyclosporine A.

ynecomastia, characterized by the growth of breast glandular tissue in boys, is occasionally seen in clinics. This growth can manifest at any age, but 40% of cases present in adolescent boys. Even though gynecomastia is a benign condition, patients are often emotionally burdened by this condition. The pathophysiological process of gynecomastia is mainly due to the imbalance between testosterone and free estrogen effects on the breast tissue, and hormone therapy. The disease is characterized by declined testosterone and slightly elevated estrogen. In general, the impaired synthesis of testosterone results in an increased release of gonadotropin, such as luteinising hormone (LH) and follicle-stimulating hormone (FSH) if the pituitary gland continues to secrete a sufficient amount of hormone. However, an inflammation in the pituitary gland, such as lymphocytic hypophysitis, can lead to pituitary cell destruction and eventually to hypopituitarism. Under such circumstances, LH and FSH would not be sufficiently released to meet the requirement for the testis to be stimulated correspondingly. One case of gynecomastia, with obesity and underdeveloped testis and penis as simultaneous characteristics, was successfully cured after a low dose of cyclosporine A (CsA) was administered to the patient, who had been suspected of having hypophysitis, which was indirectly detected by muscular biopsy.