- 期刊
使用睪固酮治療老年男性女乳症之病例報告
Elderly Gynecomastia Treated by Testosterone-A Case Report
摘要
老年人的男性女乳症應特別小心，因為：必須與乳癌作鑑別診斷、可能在身體其他地方有癌症、可能有其它內分泌的異常、可能是由其它慢性病所造成的、可能與老年人平時所服用的藥物有關、可能會轉變成癌症。診斷上是：病史、理學檢查、一般全身生化檢查、血球例行檢查、小便例行檢查、大便例行檢查、胸部X光檢查、腹部X光檢查、內分泌學檢查、愛滋病檢查、腫瘤標誌、腹部／骨盆腔電腦斷層攝影或核磁共振檢查、腹部／睪丸超音波檢查。內分泌學檢查包括：睪固酮(testosterone)、雌二醇(estradiol)、黃體激素(luteinizing hormone, LH)、濾泡刺激素(follicle stimulating hormone, FSH)、人類胎盤絨毛性激素(human chorionic gonadotropin, hCG)、泌乳激素(prolactin)、親甲狀腺素(thyroid stimulating hormone, TSH)、游離甲狀腺素(freeT4)、游離三碘甲狀腺胺酸(freeT3)、親腎上腺皮質激素(adrenocorticotrophic hormone, ACTH)、腎上腺皮質素(cortisol)。如果懷疑有遺傳的問題，可做基因學的檢查。在治療上，主要是針對原因來治療。如睪固酮缺乏可以補充睪固酮。如果動情激素(estrogen) 過多可以用選擇性雌激素接受器調節素(selective estrogen receptor modulator, SERM)。如果芳香族酶活性(aromatase activity)過高，可用芳香族酶抑制劑(aromatase inhibitor)。以上治療都無效，而且必要時，可以開刀切除。
並列摘要
Elderly patients with gynecomastia should be carefully evaluated, because (1) it should be differentiated from breast cancer、(2) there may be cancers in other parts of the body、(3) there may be other endocrine disorders、(4) it may be related to drugs taken by the patient、(5) gynecomastia may undergo malignant changes. Diagnostic tools include: Hx、PE、SMA(sequential multi-channel analysis)、BUS routines、Chest P-A、KUB、endocrinological studies、tumor markers、abdominal/pelvic CT or MRI. Endocrinological studies include: serum testosterone、estradiol、LH、FSH、hCG、prolactin、TSH、freeT3、freeT4、ACTH、cortisol. If hereditary disorders are suspected, gene studies may be indicated. Treatment is directed to the underlying causes. If testosterone is deficient, testosterone may be replaced. If estrogen is excessive, selective estrogen receptor modulators may be used. If aromatase activity is too high, aromatase inhibitor may be used. If all in vain, mastectomy may be performed.