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The man with bilateral nipple pain
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Official websites use. Share sensitive information only on official, secure websites. The man with bilateral nipple pain. Malays Fam Physician ;8 3 ; Figure 1 is a picture of a year-old male patient who presents with progressive painful enlargement of the areolae of 10 months' duration. There was no bleeding or nipple discharge. He was diagnosed with human immunodeficiency virus HIV infection 16 months ago and was initiated on antiretroviral therapy ARV , which consisted of zidovudine, lamivudine and efavirenz. Physical examination was unremarkable except for bilateral breast enlargement and right-sided old shingles scar in the T4 dermatome distribution. How to clinically differentiate between true gynaecomastia, pseudogynaecomastia and breast carcinoma? However, numerous adverse effects and limitations in tolerability remain a concern. The exact mechanism of efavirenz-induced gynaecomastia remains unknown. Two possible mechanisms have been postulated: a gynaecomastia due to immune restoration processes and b efavirenz-mediated oestradiol-like effects. There has been no report of gynaecomastia associated with trimethoprimsulphamethoxazole Bactrim , whereas zidovudine and lamivudine seem to have protective effect against gynaecomastia. True gynaecomastia is an enlargement of the male breast due to proliferating glandular tissue. However, in patients with pseudogynaecomastia, no such disk of tissue is found. Tenderness may be observed in gynaecomastia of less than 6 months' duration. Breast carcinoma is usually hard or firm, located outside the nipple—areolar complex, and is mostly unilateral. It may be associated with skin dimpling, nipple retraction, nipple bleeding or discharge. Once the diagnosis of gynaecomastia is established, conditions to consider in adolescents and young adults with gynaecomastia are physiologic pubertal gynaecomastia, Klinefelter's syndrome, familial or sporadic excessive aromatase activity, incomplete androgen insensitivity, feminising testicular or adrenal tumours, and hyperthyroidism. Medications associated with gynaecomastia include spironolactone, phenytoin, metoclopramide, cimetidine, HAART and antiandrogens used for the treatment of prostate cancer. Drug abuse, especially with anabolic steroids, alcohol, marijuana and opioids are also considered to cause gynaecomastia. Switching from efavirenz to an alternative antiretroviral drug may be one potential strategy to alleviate this adverse effect. However, multiple factors need to be considered before switching to an alternative therapy. Tamoxifen and other anti-oestrogens may be useful in the treatment of efavirenz-induced gynaecomastia. A randomised control trial would be necessary to fully evaluate the utility, and more importantly tolerability, of anti-oestrogens as a treatment for efavirenz-induced gynaecomastia. If gynaecomastia has been present for more than 1 year, it is unlikely to regress substantially, either spontaneously or with medical therapy, due to the presence of fibrosis. Fortunately, gynaecomastia did not progress further and ceased to be a concern for the patient several months after its detection. The authors would like to thank the Director General of Health Malaysia for giving the permission to publish this paper. Gynaecomastia is a common clinical condition and can co-exist with a number of different disorders. Gynaecomastia should not be underestimated as it can be physically embarrassing and psychologically distressing for patients. Clinicians need to be aware of HAART regimens side effects that could possibly lead to non-adherence and eventually therapy failure. As a library, NLM provides access to scientific literature. Malays Fam Physician. Find articles by HC Hong. Find articles by KC Koh. Collection date Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.
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Trafficking cannabis in Malaysia can get you 30 years jail and a bruised backside
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Trafficking cannabis in Malaysia can get you 30 years jail and a bruised backside
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