Endocrine Abstracts

JOINT3855

Introduction: Gynecomastia has been described in HIV-infected men undergoing highly active antiretroviral therapy. However, data on the relationship between gynecomastia and a specific antiretroviral drug or hormonal abnormality are insufficient.

Observation: Patient aged 60 years with pulmonary tuberculosis treated 04 months ago. The patient has been treated for HIV infection for 06 months and is on combination antiretroviral therapy containing Efavirenz600mg/Emtricitabine200mg/Tenofovir disoproxil fumarate 245mg daily. Referred to our training for exploration of a left Gynecomastia with palpation of an indurated and nodular mass on the left side without axillary adenopathy with a normal contralateral examination as well as the External Genitalia with right and left testicle size measuring 3*4cm and penis size at 10cm. Mammary ultrasound showed glandular infiltration of the left breast with no individualized mass or collection, complemented by mammography finding a benign-looking left gynecomastia. Liver, kidney and thyroid tests were normal. Hormonal profile: Prolactin 4.7ng/ml Testosterone =4.78ng/ml Oestradiol=22.59pg/ml FSH =11.90mui/ml LH=8.79mui/ml Tumor markers AFP and BhCG negative Testicular ultrasound was normal except for a slight reduction in left testicular volume (38*16*29mm) compared with right (43*19*28mm). In view of the patient’s severe discomfort, a local hormone treatment based on androstanolone gel 2.5% with daily cutaneous application was prescribed and the patient will be evaluated after 3 months.

Discussion: Gynecomastia is not uncommon in HIV-infected men on antiretroviral therapy, and is generally transient. Treatment with efavirenz and didanosine is associated with the development of gynecomastia. Underlying hypoandrogenism appears to contribute to the development of this disorder in these patients. Gynecomastia is initially unilateral, but progresses to bilateral but asymmetric disease in more than half of patients. In patients with persistent gynecomastia, testosterone has proved effective and safe when administered transdermally or intramuscularly over several weeks or months. Most cases developed within the first two years of treatment. Discontinuation of efavirenz had positive results, with most cases achieving complete resolution. Active screening and early discontinuation of efavirenz in patients who develop gynecomastia are recommended to improve quality of life and promote adherence to antiretroviral therapy.

Bibliography: 1. Clinical Infectious Diseases, Volume 39, Issue 10, 15 November 2004, Pages 1514–1519, https://doi.org/10.1086/425363. 2. Njuguna, C., Swart, A., Blockman, M. et al. Cases of antiretroviral-associated gynaecomastia reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa. AIDS Res Ther 13, 40 (2016). https://doi.org/10.1186/s12981-016-0121-z.