Original Article
Beneficial effects of raloxifene and tamoxifen in the treatment of pubertal gynecomastia

https://doi.org/10.1016/j.jpeds.2004.03.057Get rights and content

Abstract

Objectives

To assess the efficacy of the anti-estrogens tamoxifen and raloxifen in the medical management of persistent pubertal gynecomastia.

Study design

Retrospective chart review of 38 consecutive patients with persistent pubertal gynecomastia who presented to a pediatric endocrinology clinic. Patients received reassurance alone or a 3- to 9-month course of an estrogen receptor modifier (tamoxifen or raloxifene).

Results

Mean (SD) age of treated subjects was 14.6 (1.5) years with gynecomastia duration of 28.3 (16.4) months. Mean reduction in breast nodule diameter was 2.1 cm (95% CI 1.7, 2.7, P <.0001) after treatment with tamoxifen and 2.5 cm (95% CI 1.7, 3.3, P <.0001) with raloxifene. Some improvement was seen in 86% of patients receiving tamoxifen and in 91% receiving raloxifene, but a greater proportion had a significant decrease (>50%) with raloxifene (86%) than tamoxifen (41%). No side effects were seen in any patients.

Conclusion

Inhibition of estrogen receptor action in the breast appears to be safe and effective in reducing persistent pubertal gynecomastia, with a better response to raloxifene than to tamoxifen. Further study is required to determine that this is truly a treatment effect.

Section snippets

Methods

A retrospective chart review was conducted of all patients with pubertal gynecomastia who presented to the Endocrinology Clinic at the Children's Hospital of Eastern Ontario between July 1995 and September 2000. Patients had been treated with either reassurance alone, tamoxifen 10 to 20 mg orally twice a day for 3 to 9 months, or raloxifene 60 mg orally once daily for 3 to 9 months. The choice of therapy was based on current clinical practice in the clinic with an increasing trend over time

Results

A total of 37 patients were assessed for gynecomastia, of whom 12 received no specific medical therapy. Eighteen patients were treated with tamoxifen and 10 with raloxifene. Three subjects treated with tamoxifen were excluded for lack of follow-up.

A baseline hormonal profile was normal in all treated patients including luteinizing hormone (LH), follicle-stimulating hormone, testosterone, and estradiol. Human chorionic gonadatropin and thyroid function tests, when measured, were also normal.

Discussion

Pubertal gynecomastia is defined as benign breast enlargement occurring during male puberty without evidence of endocrinopathy, underlying disease, or drug effect. Typically, it appears at least 6 months after male secondary sexual characteristics are seen and peaks at Tanner growth stage 3 to 4 of puberty. Prevalence studies have varied widely, ranging from a peak prevalence of 8.2% at 13 years of age8 to 64.6% of boys 14 years of age.1 In the latter study, the gynecomastia persisted for 2 or

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