Q68: Endocrinology: PLAB/UK(MLA)/AKT Exam style question
Today we will discuss another Q68 Endocrinology PLAB 1/ UKMLA exam style question.
A 61-year-old man with a history of hypertension and type 2 diabetes presents to GP with concerns about the enlargement of his breast tissue over the past six months. He has become increasingly self-conscious and is apprehensive about going on holiday during the summer. Upon examination, the GP notes that the patient is overweight, has asymmetric enlargement of breast tissue, and a recent increase in abdominal girth. The GP suspects gynecomastia and considers potential drug-related causes.
Which one of the following medications, recently added to the patient's treatment regimen, is most likely to be associated with the development of gynecomastia in this patient?
A. Metformin
B. Lisinopril
C. Digoxin
D. Finasteride
E. Glimepiride
Explanation:
The correct answer is D. Finasteride.
Gynecomastia is characterized by the benign enlargement of male breast tissue due to an imbalance of estrogen and testosterone levels. Several factors can contribute to gynecomastia, including aging, obesity, hypogonadism, hyperthyroidism, liver disease, and the use of certain medications.
Let's analyze the medications listed in the question:
A. Metformin - An oral antidiabetic agent used for treating type 2 diabetes. Metformin is not commonly associated with gynecomastia.
B. Lisinopril - An angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and heart failure. It is not typically associated with gynecomastia.
C. Digoxin - A cardiac glycoside used to treat heart failure and atrial fibrillation. Although it has several side effects, gynecomastia is not a common one.
D. Finasteride - A 5-alpha-reductase inhibitor used to treat benign prostatic hyperplasia (BPH) and male pattern hair loss. Finasteride is known to cause gynecomastia due to its inhibition of testosterone conversion to dihydrotestosterone (DHT), resulting in an imbalance of estrogen and testosterone levels.
E. Glimepiride - A sulfonylurea used for treating type 2 diabetes. It is not commonly associated with gynecomastia.
In this case, finasteride is the most likely medication to be responsible for the patient's gynecomastia. It is essential to evaluate the patient's medication history and consider alternative medications if appropriate while also addressing any underlying conditions that may contribute to gynecomastia.
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Reference:
NICE evidence summary on the use of finasteride for treating male pattern baldness. It states that finasteride is licensed for treating benign prostatic hyperplasia (BPH) at a dose of 5 mg daily, but it is also used off-label for treating male pattern baldness at a lower dose of 1 mg daily. It also mentions that gynecomastia is a rare but possible adverse effect of finasteride, occurring in less than 1 in 1000 patients.
NICE guideline on the diagnosis and management of prostate cancer. It includes recommendations on the use of 5-alpha-reductase inhibitors, such as finasteride, for men with lower urinary tract symptoms (LUTS) due to BPH. It advises that men should be informed of the potential benefits and harms of these drugs, including the risk of gynecomastia.
NICE guideline on the assessment and management of non-cancerous breast conditions. It covers the diagnosis and treatment of various benign breast problems, including gynecomastia. It suggests that men with gynecomastia should be assessed for possible causes, such as medication use, and that treatment options should be discussed with them. It also states that surgery may be considered for men with persistent or severe gynecomastia that affects their quality of life.
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