To understand the pathophysiology of spironolactone-induced gynecomastia, there is a need to understand two important concepts.
Definition
Spironolactone is a potassium-holding water pill which helps in maintaining the right level of potassium in the body, and in resisting excessive salt absorption. Aldactone is the brand name of spironolactone and it was introduced as a generic medicine in 1959.
Spironolactone has been primarily utilized as a treatment for kidney, heart and liver diseases. When the adrenal glands produce too much aldosterone hormone, spironolactone is introduced in the body to combat the effects of aldosterone.
Spironolactone (Aldactone) Induced Gynecomastia
One of the side effects of spironolactone in males is breast enlargement. Continuous intake of Aldactone leads to an increase in estradiol levels and a decrease in testosterone levels. This hormonal imbalance in males can lead to pain and swelling of the breast.
• Male Adolescents
When breast enlargement happens in teenage males, this might be caused by puberty. Although considered normal, it is also essential to regard the use of steroids, recreational drugs, and alcohol abuse as reasons for enlargement of breast.
Adolescents also go through hormonal imbalance, leading to the development of acne. Some acne medications are topical while some are taken orally. Acne oral medications often contain spironolactone which can trigger the increase in estradiol and decline in testosterone level. Essentially, this phenomenon will cause breast enlargement.
• Liver Cirrhosis Patients
One of the symptoms of kidney failure is breast enlargement. However, it has been found that kidney failure is not necessarily the main underlying condition for breast enlargement in men. There is a need to consider the fact that Aldactone, a medication used to reduce edema in kidney, can also be the reason for this particular issue in men.
Kidney failure is one of the causes of breast enlargement but it was found that a medication used for kidney disease may also be the reason for this condition. When a certain group of kidney patients were introduced in Spironolactone, there was an increase in estradiol and a decrease in testosterone compared to those who did not take the same medicine.
When this group stopped using this medication, the issue was resolved. Therefore, the case of breast enlargement was drug-induced rather than a symptom of kidney failure.
• Aging Men
There are cases where adult males develop enlarged breasts not because of hormonal changes due to aging, but because of the drugs they are taking. In the case of a 76-year old patient with congestive heart disease and has developed enlargement of breast, this may be a drug-induced gynecomastia.
Upon further investigation, it was found that his medication involves 25mg daily dosage of spironolactone. The permanent use of this potassium-sparing pill has caused his androgen to be displaced from its receptor. Eventually, estradiol production increased as testosterone level diminished.
When they substituted his spironolactone medication with an aldosterone receptor medicine called eplenerone, his symptoms started to stabilize. After 3 months, his breast came back to normal.
In order to reverse the effects of spironolactone-induced breast enlargement for males, the patient can either refrain from taking the medication or ask his physician for a substitute (such as Triamterene and Amiloride).
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