Muhammad Adamas, Tjahjo Djojo Tanojo, Supardi

Ginekomastia pada remaja laki-laki: apa yang dapat dilakukan? laporan kasus

Introduction

Ginekomastia pada remaja laki-laki: apa yang dapat dilakukan? laporan kasus. Kasus ginekomastia pubertas persisten pada remaja obesitas. Membahas diagnosis, manajemen multidisipliner, terapi hormonal, dan peran androlog atasi dampak fisik serta psikologis.

Abstract

Background: Gynecomastia is defined as a benign enlargement of the male breast glandular tissue, representing an imbalance between androgen and estrogen activity rather than a distinct pathological entity. While gynecomastia may occur physiologically during periods of hormonal fluctuation such as neonatal, pubertal, and elderly phases, it can also arise pathologically from diverse etiologies. Early recognition and appropriate management are essential to prevent both physical and psychological distress. This report aims to present a case of persistent pubertal gynecomastia in an obese adolescent male, emphasizing its diagnostic challenges and multidisciplinary management approach. Case Presentation: We report the case of a 15-year-old male presenting with bilateral breast enlargement persisting for five years. The enlargement progressed gradually, was painless, and caused significant body image concern. The patient was classified as having grade II obesity and exhibited palpable, firm, non-mobile, 3-cm discs beneath both areolae, consistent with Simon grade 2A gynecomastia. Signs of virilization were appropriate for pubertal age. Hormonal evaluation revealed Estradiol 44.2 pg/mL, Testosterone 246 ng/dL, LH 1.13 mIU/mL, and a Testosterone/Estradiol ratio of 5.6, suggesting a relative estrogenic predominance. The patient was treated sequentially with Tamoxifen 10 mg and Letrozole 2.5 mg for two weeks each. Counseling addressed possible etiologies, the importance of lifestyle modification, pharmacological options, cosmetic surgery considerations, and reproductive and sexual health guidance. Conclusion: This case underscores that adolescent gynecomastia, although sometimes physiological, may become a substantial physical and psychological complaint. Comprehensive evaluation, including detailed anamnesis, clinical examination, and hormonal testing, is pivotal for diagnosis and etiologic assessment. An andrologist plays a crucial role in providing integrated management and counseling on reproductive and sexual function. Latar Belakang: Ginekomastia merupakan pembesaran jinak jaringan kelenjar payudara pada laki-laki yang mencerminkan ketidakseimbangan antara aktivitas androgen dan estrogen, bukan suatu penyakit tersendiri. Kondisi ini dapat bersifat fisiologis pada masa perubahan hormonal seperti periode neonatal, pubertas, dan usia lanjut, namun juga dapat bersifat patologis dengan berbagai etiologi. Deteksi dini dan tata laksana yang tepat penting untuk mencegah dampak fisik maupun psikologis. Tujuan penulisan laporan kasus ini adalah untuk memaparkan kasus ginekomastia pubertas yang persisten pada remaja dengan obesitas, serta menyoroti tantangan diagnostik dan pendekatan penanganan multidisipliner yang diterapkan. Presentasi Kasus: Seorang remaja laki-laki berusia 15 tahun dengan keluhan pembesaran payudara bilateral sejak lima tahun sebelumnya. Pembesaran berlangsung perlahan tanpa nyeri maupun keluarnya cairan, namun menimbulkan gangguan terhadap citra tubuh. Pasien tergolong obesitas derajat II, dengan temuan diskus kenyal berdiameter 3 cm di kedua areola yang tidak mobile, sesuai dengan ginekomastia derajat 2A menurut Simon. Tanda virilisasi sesuai usia pubertas. Pemeriksaan hormonal menunjukkan Estradiol 44,2 pg/mL, Testosteron 246 ng/dL, LH 1,13 mIU/mL, dan rasio T/E 5,6 yang mengindikasikan dominasi relatif estrogen. Terapi diberikan berupa Tamoxifen 10 mg dan Letrozole 2,5 mg masing-masing selama dua minggu. Edukasi meliputi kemungkinan penyebab, pentingnya perubahan gaya hidup, pilihan farmakoterapi, pertimbangan tindakan bedah kosmetik, serta konseling fungsi reproduksi dan seksualitas. Kesimpulan: Kasus ini menegaskan bahwa ginekomastia pada remaja, meskipun kadang fisiologis, dapat menjadi masalah bermakna secara fisik maupun psikologis. Evaluasi menyeluruh melalui anamnesis, pemeriksaan fisik, dan pemeriksaan hormonal sangat penting untuk menegakkan diagnosis dan menentukan etiologi. Peran seorang androlog adalah memberikan tata laksana komprehensif disertai konseling fungsi reproduksi dan seksual pasien.

Review

This case report, titled "Ginekomastia pada remaja laki-laki: apa yang dapat dilakukan? laporan kasus" (Gynecomastia in adolescent males: what can be done? a case report), addresses a highly relevant and often under-discussed clinical issue. The abstract effectively highlights that while pubertal gynecomastia can be physiological, its persistent nature, especially when compounded by factors like obesity, can lead to significant physical and psychological distress in adolescents. The stated aim to elucidate diagnostic challenges and the benefits of a multidisciplinary management approach is pertinent, setting clear expectations for the detailed case presentation that follows. The strengths of this report lie in its methodical presentation of a representative case. The 15-year-old obese male with five years of persistent bilateral breast enlargement, consistent with Simon grade 2A gynecomastia, provides a robust clinical example. The diagnostic approach is commendable, including detailed hormonal evaluation (Estradiol, Testosterone, LH, and the critical Testosterone/Estradiol ratio), which precisely identifies a relative estrogenic predominance as the underlying mechanism. Furthermore, the described management strategy is comprehensive, encompassing sequential pharmacological interventions with Tamoxifen and Letrozole, alongside extensive counseling on lifestyle modifications, pharmacological options, surgical considerations, and crucial reproductive and sexual health guidance. This truly underscores the value of an integrated, patient-centered approach, particularly highlighting the pivotal role of an andrologist. In conclusion, this case report serves as an excellent illustration of the complexities involved in managing adolescent gynecomastia and strongly advocates for a thorough, multidisciplinary strategy. It effectively reinforces that comprehensive evaluation—beyond mere clinical observation—is essential for accurate diagnosis and tailored etiologic assessment. While the abstract focuses on the treatment *approach* rather than the specific *outcomes* of the sequential pharmacological therapy given, the detailed description of the diagnostic and management process offers valuable practical guidance for clinicians. This paper is a timely reminder for healthcare providers to address this condition proactively, mitigating both the physical and psychological burdens faced by affected adolescents.

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