verezdoВестник репродуктивного здоровьяBulletin of Reproductive Health2075-65692310-421XEndocrinology Research Centre (Moscow)10.14341/brh12752verezdo-12752Research ArticleНАУЧНЫЙ ОБЗОРREVIEWГинекомастия: патогенез и подходы к лечебной тактикеGynecomastia: pathogenesis and approaches to treatmenthttps://orcid.org/0000-0002-5645-9836ЭриставиС. Х.EristaviS. Kh.

Эристави Саида Хачимовна, врач-эндокринолог , аспирант отделения андрологии 

117036, Москва, ул. Дм. Ульянова, д. 11

Saida Kh. Eristavi, MD

11 Dm. Ulyanova street, 117036 Moscow

eristaavi@gmail.comРоживановР. В.RozhivanovR. V.

Роживанов Роман Викторович, д.м.н.

Roman V. Rozhivanov, MD, PhD]

rrozhivanov@mail.ruhttps://orcid.org/0000-0002-4195-7234РоживановаЕ. Р.RozhivanovaE. R.

Роживанова Екатерина Романовна

Ekaterina R. Rozhivanova, MD

erozhivanova@mail.ruhttps://orcid.org/0000-0001-8425-0020АндрееваЕ. Н.AndreevaE. N.

Андреева Елена Николаевна, д.м.н., профессор

Elena N. Andreeva, MD, PhD, Professor

endogin@mail.ruhttps://orcid.org/0000-0002-5634-7877МельниченкоГ. А.Mel’nichenkoG. A.

Мельниченко Галина Афанасьевна, д.м.н., профессор, академик РАН

Galina A. Mel’nichenko, MD, PhD, Professor

teofrast2000@mail.ruhttps://orcid.org/0000-0002-9717-9742МокрышеваН. Г.MokryshevaN. G.

Мокрышева Наталья Георгиевна, д.м.н., профессор, член-корр. РАН 

Natalya G. Mokrysheva, MD, PhD, Professor

nm70@mail.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian FederationНациональный медицинский исследовательский центр эндокринологии; Российский университет медициныРоссияEndocrinology Research Centre; Russian University of MedicineRussian Federation202531032025413238Copyright © Эристави С.Х., Роживанов Р.В., Роживанова Е.Р., Андреева Е.Н., Мельниченко Г.А., Мокрышева Н.Г., 20252025Эристави С.Х., Роживанов Р.В., Роживанова Е.Р., Андреева Е.Н., Мельниченко Г.А., Мокрышева Н.Г.Eristavi S.K., Rozhivanov R.V., Rozhivanova E.R., Andreeva E.N., Mel’nichenko G.A., Mokrysheva N.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vrz-endojournals.ru/jour/article/view/12752

Гинекомастия — доброкачественное увеличение грудных желёз у мужчин, которое может быть физиологическим, патологическим или идиопатическим. Физиологическая гинекомастия может развиться и у детей в период полового созревания. Патологическая гинекомастия связана с различными эндокринными, генетическими нарушениями, системными заболеваниями, паранеопластическими процессами, или может быть ятрогенной. Частыми причинами патологической гинекомастии являются гипогонадизм, опухоли яичек или надпочечников, вырабатывающие эстрогены, синдромы избытка андрогенов с ароматизацией, андрогенные дефициты, гепатопатия и нефропатия. Чаще всего в основе гинекомастии лежит нарушение баланса между эстрогенами и андрогенами. Известно, что лечение синдромов, вызвавших гинекомастию, зависит от этиологии и патогенеза, но гинекомастия сама по себе устраняется, как правило, хирургически. Использование медикаментозной терапии гинекомастии является обсуждаемым. Возможно, она была бы уместной в случаях гинекомастии, обусловленной нарушением баланса между эстрогенами и андрогенами, при условии начального этапа развития гинекомастии. Основными кандидатами на проведение медикаментозного лечения гинекомастии являются антиэстрогены и ингибиторы ароматазы. Эти аспекты обсуждаются в обзоре.

Gynecomastia is a benign enlargement of the breast glands in men that can be physiologic, pathologic, or idiopathic. Physiologic gynecomastia can occur in children and during puberty. Pathologic gynecomastia is associated with various endocrine, genetic disorders, systemic diseases, paraneoplastic processes, or may be iatrogenic. Common causes of pathologic gynecomastia are hypogonadism, testicular or adrenal tumors producing estrogens, androgen excess syndromes with aromatization, androgen deficiencies, hepatopathy, and nephropathy. Most commonly, the underlying cause of gynecomastia is an  imbalance between estrogens and androgens. It is known that the treatment of syndromes causing gynecomastia depends on the etiology and pathogenesis, but gynecomastia itself is eliminated, as a rule, surgically. The use of drug therapy for gynecomastia is debated. It would probably be appropriate in cases of gynecomastia due to an imbalance between estrogens and androgens, given the initial stage of gynecomastia development. The main candidates for drug treatment of gynecomastia are anti-estrogens and aromatase inhibitors. These aspects are discussed in the review.

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The authors declare that there are no conflicts of interest present.