عم أبراهيم عنده gynecomastia ياتري ليه ؟ case 7

Tahnk you for your efforts

Chronic heart failure is not the underlying cause

I think gynecomastia in this case is a complication of medical therapy

Heart failure patients frequently receive spironolactone,
usualy in conjunction with frosemide

Spironolactone,a potassium sparing diuretic,is also
classified as Aldosterone receptor antagonist

Important note

Not all potassium sparing diuretics are Aldosterone receptor antagonists
Amiloride and triamterene work by
blocking the tubular epithelial Na channels.



So aldosterone (as well as another aldosterone receptor antagonist
called eplerenone) are associated with endocrine side effects including

Gynecomastia
Testicular atrophy
Menstrual irregularities


Spironolactone in chronic heart failure

Spironolactone in heart failure is used in a small dose
(antifailure dose) that ranges from 25-50 mg/day


Note:Diuretic dose is larger ,and starts from 100mg/day


Diuretic effect is not the main benefit in CHF, it is thought
that the main mechanism of action is by antagonizing the deleterious effects of aldosterone on cardiac remodeling

Eplerenone can be used also and has the same benefit







.

احتمال بعيد جدا

Patients with chronic heart failure frequently complain of GIT
symptoms related to GIT congestion!!

In the past, cimetidine (H2 blocker) to to decrease gastric
acid secretion and consequently to relieve some of
these symptoms

Cimetidine is known to cause gynecomastia,and it is no
longer used

Ranitidine and famotidine don't cause this unwanted side effect