#1
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Èñòèííàÿ ãèíåêîìàñòèÿ. Ëå÷åíèå?
Äîáðûé äåíü!
ß âðà÷-ýíäîêðèíîëîã èç Êèøèíåâà, Ìîëäîâà. Õî÷ó ïîïðîñèòü ñîâåòà. Ïàöèåíò,ìóæ÷èíà, 29 ëåò, íîðìîñòåíèê. Ðîñò 1,80 ì. Âåñ 75 êã. Æàëîáû íà óâåëè÷åíèå ìîëî÷íûõ æåëåç, âèçóàëüíûé äèñêîìôîðò. Ïðîáëåìà ñóùåñòâóåò îêîëî 3-4 ëåò. Æàëîá íà ïîëîâóþ ôóíêöèþ íå ïðåäúÿâëÿåò è ãîâîðèò, ÷òî íèêîãäà íå áûëî ïðîáëåì â ýòîé îáëàñòè. Î÷åíü àêòèâíûé, 5-6 ðàç â íåäåëþ çàíèìàåòñÿ ñïîðòîì. Àëêîãîëü è ïðèìåíåíèå íàðêîòèêîâ îòðèöàåò.  17-18 ëåò â ñïîðòçàëå òðåíåð äàâàë åìó òàáëåòêè äëÿ óâåëè÷åíèÿ ìûøå÷íîé ìàññû, âîçìîæíî òåñòîñòåðîí. Ïðèíèìàë îêîëî 6 ìåñÿöåâ. Îñåíüþ 2014 ãîäà ó àíäðîëîãà áûë óñòàíîâëåí äèàãíîç: Äâóõñòîðîííÿÿ ãèíåêîìàñòèÿ íà ôîíå ïåðâè÷íîãî ãèïîãîíàäèçìà. Ëàáîðàòîðíûå äàííûå çà îêòÿáðü 2014: ñâ. òåñòîñòåðîí 7.5 (8.7-54.7), ýñòðàäèîë 88.0 (7.63-42.6). Ïàöèåíò ïîëó÷èë äåñÿòü èíúåêöèé Õîðèîíè÷åñêîãî Ãîíàäîòðîïèíà. Ëå÷åíèå çàêîí÷èë â ôåâðàëå 2015. Ëå÷åíèå ïåðåíåñ õîðîøî, ñ åãî ñëîâ, âèçóàëüíî ïðîÿâëåíèå ãèíåêîìàñòèè íåñêîëüêî óìåíüøèëîñü. Íà ÓÇÈ ìîëî÷íûõ æåëåç îïðåäåëÿåòñÿ æåëåçèñòàÿ òêàíü, ñïðàâà ðàçìåðàìè 17x5 ìì è ñëåâà 7x8 ìì. ÓÇÈ ÿè÷åê áåç èçìåíåíèé. Ëàáîðàòîðíûå äàííûå, èþëü 2015:TSH 1.1 (0.0-4.0), prolactin 6.1 (1.8-17.0), LH 2.9 (0.7-7.4), FSH 3.2 (1.0 - 14.0), testosteron 14.2 (5.54-25.2), estradiol 323,3 (7.63-42.6), AFP 4.3 (0-10), b-hCG 0.96 (0-1.06). Áèîõèìè÷åñêèå ïîêàçàòåëè êðîâè â íîðìå. Ïàòîëîãèè ïå÷åíè íåò. Îáñëåäîâàíèå ïðîñòàòû è ñïåðìîãðàììà - áåç îòêëîíåíèé. Ïðè ïàëüïàöèè ìîëî÷íûõ æåëåç- îáðàçîâàíèÿ ñ îáåèõ ñòîðîí óìåðåííî-ïëîòíûå, îäíîðîäíûå, áåçáîëåçíåííûå, áåç âûäåëåíèé, ðàçìåðû îêîëî 1-2 ñì. Ñòîèò ëè íàçíà÷èòü òàêîìó ïàöèåíòó òàìîêñèôåí? Ïîìîæåò ëè îí óìåíüøèòü îáðàçîâàíèÿ? ×åñòíî ïðèçíàþñü, íè ðàçó íå íàçíà÷àë ýòîò ïðåïàðàò. Êîëëåãè, áóäó áëàãîäàðåí, åñëè ïîìîæåòå ðàçîáðàòüñÿ â ýòîé ñèòóàöèè. |
#2
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Ïàëüïàöèÿ/ÓÇÈ òåñòèêóë? Èñòî÷íèêîì ýñòðàäèîëà ìîæåò áûòü îïóõîëü.
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#3
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Íà îñíîâàíèè êàêèõ äàííûõ áûë óñòàíîâëåí äèàãíîç ïåðâè÷íîãî ãèïîãîíàäèçìà?
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#4
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Ñïàñèáî çà îòêëèê! Ñ òåñòèêóëàìè âñå â íîðìå. Áûë íà îñìîòðå ó óðîëîãà è íà ÓÇÈ áåç ïàòîëîãèè.
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#5
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Ñëåäóùèì øàãîì, íàâåðíîå, èìååò ñìûñë âûïîëíèòü âèçóàëèçàöèþ íàäïî÷å÷íèêîâ - ýñòðîãåíïðîäóöèðóþùåå îáðàçîâàíèå ìîæåò áûòü òàì.
Âî âñÿêîì ñëó÷àå, [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] â ðàçäåëå "Ãèíåêîìàñòèÿ" ñîäåðæèò òàêóþ ðåêîìåíäàöèþ: Öèòàòà:
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#6
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#7
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Ñïàñèáî çà ññûëêó è ïîìîùü â ñëåäóþùåì øàãå. Çíà÷èò, âûïîëíèì ÊÒ íàäïî÷å÷íèêîâ. Íà íåîäíîêðàòíûõ ÓÇÈ â îáëàñòè íàäïî÷å÷íèêîâ íè÷åãî íå áûëî âèäíî.
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#8
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À íå îøèáêà ëè â ëàáîðàòîðèè? ×åãî ó íåãî ïðè åñòðàäèîëå çà 300 ïã/ìë òàêèå íîðìàëüíûå òåñòîñòåðîí è ËÃ? Áèîäîñòóïíûé òåñòîñòåðîí ìåðÿëè?
Ðàçìåð èìåííî æåëåçèñòîé òêàíè êðàéíå ìàë; åñëè ãðóäè áîëüøèå, òî òàì æèð, à íå æåëåçà. Ôåìèíèçàöèè íå âèæó. Àíàìíåç áû õîðîøî ñîáðàòü. Îí ïðîäîëæàåò ðàñòè? Êàêèõ òîëüêî ïðè÷èí íå íàõîäèëè ó ìóæ÷èí ñ ïîâûøåííûì åñòðàäèîëîì: è êðåìû äëÿ ëûñèíû, è õèìèêàòû íà ðàáîòå, è ðåâíèâûå æ¸íû, ïîäêëàäûâàþøèå èì â êîôå ñâîè ïðîòèâîçà÷àòî÷íûå òàáëåòêè. Çàïðåø¸ííàÿ ïðàêòèêà: êóðàì íà ôåðìàõ äàâàòü åñòðîãåí äëÿ óñêîðåíèÿ ðîñòà, à îí óæ îòòóäà ïðÿìî â ñóï èëè øàøëû÷îê. Ó ìåíÿ áûë îäèí çàâ. àïòåêîé, ñ ôåìèíèçàöèåé è åñòðîãåíîì îò î÷åíü íèçêîãî äî êðàéíå âûñîêîãî. Âñ¸ èñ÷åçëî, êîãäà îäèí èç åãî ïîä÷èí¸ííûõ, ñ êîòîðûì ó íèõ áûëà âðàæäà, óø¸ë ñ ðàáîòû:-) |
#9
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Îäîáðÿëîê íå õâàòàåò. Àíàìíåç äëÿ ãèíåêîìàñòèè äîëæåí áûòü ñóïåðïîäðîáíûì...
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#10
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Ñåé÷àñ óæå íèêàêèå ëåêàðñòâà íå ïîìîãóò. Ãèíåêîìàñòèÿ ïîÿâèëàñü 3-4 ãîäà íàçàä; òîãäà è íà÷àëñÿ âñïëåñê åñòðîãåíîâ ( ñóäÿ ïî îïèñàíèþ, íî íàäî òî÷íî âûÿñíèòü áûëà ëè îíà ó íåãî â íà÷àëå ïîëîâîãî ñîçðåâàíèÿ). Òàê âîò: ïåðâûé ~ãîä ãèíåêîìàñòèÿ ñîñòîèò èç æåëåçèñòîé òêàíè,êîòîðàÿ ìîæåò óéòè ïîñëå òåñòîñòåðîíà, à ïîòîì, ìàêñèìóì ÷åðåç 2 ãîäà, îíà çàìåøàåòñÿ ñòðîìîé, ñîåäèíèòåëüíîé òêàíüþ, êîòîðàÿ íà ãîðìîíàëüíûå ìàíèïóëÿöèè óæå íå îòâå÷àåò.
Ïîñåìó, åäèíñòâåííûì ñïîñîáîì ðàçðåøèòü åãî êîñìåòè÷åñóþ ïðîáëåìó áóäåò òîëüêî îïåðàöèÿ. Ïîâûøåííûé åñòðîãåí íàäî èññëåäîâàòü è ëå÷èòü ( åñëè íàäî) îòäåëüíî. Òàê ÷òî òàìîêñèôåí íå ïîìîæåò. |
#11
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Êîëëåãè, áîëüøîå ñïàñèáî çà îòâåòû è ðåêîìåíäàöèè. Ïîâòîðèì ýñòðàäèîë, Ëà è ïîñìîòðèì ñâîáîäíûé òåñòîñòåðîí. Âûïîëíèì ÊÒ íàäïî÷å÷íèêîâ.
Àíàìíåç ïîñòàðàëñÿ ñîáðàòü òùàòåëüíî, íåêîòîðûå ìîìåíòû åùå óòî÷íþ. |
#12
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Åñëè ó÷åñòü , ÷òî íàáîðîâ äëÿ îïðåäåëåíèÿ ñâ òåñòîñòåðîíà â ïðèíöèïå âàëèäíûõ íåò, òî õîòåëîñü áû âåðèòü, ÷òî Âû îöåíèòå îáùèéè ÑÃÑÃ
Îáðàùó Âàøå âíèìàíèå, ÷òî íà ðàçäåë î ðàññïðîñå Âû âîîáùå íå îòðåàãèðîâàëè .
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Ã.À. Ìåëüíè÷åíêî |
#13
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Öèòàòà:
Plast Reconstr Surg. 2015 Feb;135(2):425-32. Correction of gynecomastia in body builders and patients with good physique. Blau M, Hazani R. BACKGROUND: Temporary gynecomastia in the form of breast buds is a common finding in young male subjects. In adults, permanent gynecomastia is an aesthetic impairment that may result in interest in surgical correction. Gynecomastia in body builders creates an even greater distress for patients seeking surgical treatment because of the demands of professional competition. The authors present their experience with gynecomastia in body builders as the largest study of such a group in the literature. METHODS: Between the years 1980 and 2013, 1574 body builders were treated surgically for gynecomastia. Of those, 1073 were followed up for a period of 1 to 5 years. Ages ranged from 18 to 51 years. Subtotal excision in the form of subcutaneous mastectomy with removal of at least 95 percent of the glandular tissue was used in virtually all cases. In cases where body fat was extremely low, liposuction was performed in fewer than 2 percent of the cases. RESULTS: Aesthetically pleasing results were achieved in 98 percent of the cases based on the authors' patient satisfaction survey. The overall rate of hematomas was 9 percent in the first 15 years of the series and 3 percent in the final 15 years. There were no infections, contour deformities, or recurrences. CONCLUSIONS: This study demonstrates the importance of direct excision of the glandular tissue over any other surgical technique when correcting gynecomastia deformities in body builders. The novice surgeon is advised to proceed with cases that are less challenging, primarily with patients that require excision of small to medium glandular tissue.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |