Sindhu Sree Rallapalli, Sunanda Tirupati, Vijaya Sarathi* and Dileep Kumar Department of Endocrinology, Narayana Medical College, India *Corresponding author: Vijaya Sarathi, Associate Professor, Department of Endocrinology, Narayana Medical College, Nellore, India Submission: April 04, 2018; Published: April 27, 2018 Horsegram Induced Gynecomastia Case Report 1/2 Copyright © All rights are reserved by Vijaya Sarathi Volume 2 - Issue 2 Introduction Gynecomastia develops due to high estrogen or low androgen levels/activity [1]. Exposure to exogenous estrogens is one of the causes, which includes excess consumption of phytoestrogens [2]. Isoflavones and flavonoids are phytoestrogens that can cause gynecomastia when ingested in high quantities. Case reports of gynecomastia due to Soy isoflavones [3]; lavender and tea tree oils [4] have been reported. Here we report a case of horse gram flavonoid induced gynecomastia. Case Report Figure 1: Bilateral gynecomastia (Left > right). A 41 years old gentleman presented to Endocrinology outpatient services with complaints of pain and enlargement of both breasts for the past 2 months. There was no history suggestive of primary or secondary hypogonadism, relevant systemic illnesses or consumption of medications/supplements. There wasn’t any history of regression of secondary sexual characters or reduced sexual desire or function. He was consuming about 100g of boiled horse gram per day for the past 4 months, for weight loss and diabetes prevention, which he started on his own after obtaining the information from internet. He temporally related onset of gynecomastia to horse gram intake with onset of gynecomastia after 4 weeks of starting horse gram consumption. Patient was obese (BMI: 28.2kg/m 2 ) and breast examination revealed tender, asymmetric bilateral gynecomastia (larger on left side), with no discharge on expression (Figure 1). External genitalia and sexual maturity rating (SMR: P5, stretched penile length: 12cm, testes volume: 20cc bilateral) were appropriate for age. Hormonal evaluation was normal except for mild elevation of serum estradiol (Table 1). Table 1: Hormonal evaluation for gynecomastia. Investigation Observed Value Serum Free thyroxine 0.94ng/dl Serum thyroid stimulating hormone 1.16µIU/ml Serum estradiol 78pg/ml Serum follicle stimulating hormone 7.16mIU/ml Testosterone 5.16ng/ml Beta human chorionic gonadotropin 0.22mIU/ml Dehydroepiandrosterone 117.9µg/dl Ultrasound of breasts revealed glandular tissue of 4.8cm x 3.2cm and 1.2cm x 1.8cm in left and right breasts respectively, and was of diffuse glandular type of gynecomastia. No radiological evidence of breast tumour was found. As there wasn’t any other etiological history except for horse gram intake, we advised him to stop its consumption; suggested lifestyle modification for weight loss and diabetes prevention. On follow up there was reduction in glandular tissue size which gradually regressed over 6 months, without any additional specific medical or surgical interventions. Abstract Gynecomastia is benign enlargement of male breast. It is caused by high estrogen to androgen ratio, attributable to various causes of estrogen excess or androgen deficiency. Herewith we report a case of gynecomastia in a middle aged man due to excess consumption of horse-gram, containing flavonoids which are estrogenic compounds. Gynecomastia regressed gradually after stopping horse-gram consumption, without any other medical or surgical interventions. Keywords: Gynecomastia; Horse-gram; Flavonoids Global Journal of Endocrinological Metabolism C CRIMSON PUBLISHERS Wings to the Research ISSN 2637-8019