title: Management of prepubertal gynecomastia in two monozygotic twins with Peutz-Jeghers syndrome: from aromatase inhibitors to subcutaneous mastectomy.
abstract: BACKGROUND
  Prepubertal gynecomastia is characterized by the presence of palpable uni- or bilateral breast tissue in boys without other signs of sexual maturation. It may be the endocrine expression of rare syndromes such as Peutz-Jeghers syndrome (PJS). This study aimed to evaluate the effectiveness of anastrozole and to describe an innovative surgical approach.
  
  
  METHODS
  This report presents twins with PJS, bilateral prepubertal gynecomastia, and testicular multifocal calcifications. Both twins were treated with anastrozole for 2 years. After finishing treatment, both were followed before subcutaneous mastectomy was performed by the "modified" Webster technique.
  
  
  RESULTS
  Growth velocity decreased and gynecomastia diminished during anastrozole treatment. After discontinuation of therapy due to a sharp reduction in growth velocity, both twins showed regrowth of gynecomastia, with painful and strained breasts. A significant reduction in breast volume with glandular removal was achieved.
  
  
  CONCLUSIONS
  The findings of this study showed a multidisciplinary approach to prepubertal gynecomastia due to the synergy of pediatricians, radiologists, and plastic surgeons. The follow-up evaluation after the anastrozole treatment showed it to be an efficacious medical treatment, as an alternative to orchidectomy, to control the effects of circulating estrogens. Moreover, the results observed in the patients confirmed the validity and feasibility of the "modified" Webster technique in terms of aesthetic and functional results, patient satisfaction, and absence of complications.
authors.affiliation: Department of Orthopedic, Traumatologic, Rehabilitative, and Plastic-Reconstructive Sciences, Second University of Naples, L. Miraglia Square 2, 80138, Naples, Italy, gaferraro@libero.it.
authors.forename: Giuseppe Andrea
authors.initials: GA
authors.lastname: Ferraro
authors.forename: Tiziana
authors.initials: T
authors.lastname: Romano
authors.forename: Francesco
authors.initials: F
authors.lastname: De Francesco
authors.forename: Anna
authors.initials: A
authors.lastname: Grandone
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Andrea
authors.forename: Emanuele Miraglia
authors.initials: EM
authors.lastname: del Giudice
authors.forename: Chiara
authors.initials: C
authors.lastname: Cataldo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Gatta
authors.forename: Graziella
authors.initials: G
authors.lastname: Di Grezia
authors.forename: Laura
authors.initials: L
authors.lastname: Perrone
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Nicoletti
mesh_terms: D000311:Adrenal Glands / Q000000981:diagnostic imaging; D000077384:Anastrozole; D047072:Aromatase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D015897:Comorbidity; D004200:Diseases in Twins / Q000628:therapy*; D006177:Gynecomastia / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D020347:Lithiasis / Q000473:pathology; D008297:Male; D015414:Mastectomy, Subcutaneous / Q000379:methods; D009570:Nitriles / Q000008:administration & dosage / Q000627:therapeutic use*; D010580:Peutz-Jeghers Syndrome / Q000097:blood / Q000150:complications; D012008:Recurrence; D013733:Testicular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D013737:Testis / Q000000981:diagnostic imaging / Q000473:pathology; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D016217:Ultrasonography, Mammary
chemical_list: D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D000077384:Anastrozole