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Table 1 Causes of prepubertal gynecomastia[14, 10, 12]

From: Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report

Type Details
Idiopathic No known cause
Exposure to exogenous estrogens • Dermal and hair preparations (e.g. lavender and tea tree oils)
• Milk and meat of cows treated with estrogens
Illness • Liver disease (e.g. cirrhosis)
• Renal failure
• Thyrotoxicosis
• Malnutrition
Neoplasia • Adrenal
• Testicular
Congenital adrenal hyperplasia • (Late-onset) 21-hydroxylase deficiency (21-OHD)
• 11-beta-hydroxylase deficiency
• Overexpression of aromatase
Other hormonal aberrations • Androgen deficiency (e.g. congenital adrenal hyperplasia)
• Androgen insensitivity
• Extraglandular aromatization of androstenedione (e.g. aromatase excess syndrome (AES), obesity)
Medication • Anti-androgens (e.g. bicalutamide, flutamide, finasteride, spironolactone)
• Antimicrobials (e.g. antiretrovirals, isoniazid, ketoconazole, metronidazole, penicillamine)
• Antineoplastic and immunomodulators (e.g. alkylating agents, bleomycin, cisplatin, cyclosporine, methotrexate, vincristine)
• Gastrointestinal agents (e.g. cimetidine, metoclopramide, omeprazole, ranitidine)
• Cardiovascular (e.g. amiodarone, amlodipine, angiotensin-converting enzyme inhibitors, calcium channel blockers, digitoxin, fibrates, reserpine, spironolactone, statins)
• Hormones (e.g. androgens, chorionic gonadotropin, estrogens, GnRH agonist, GH)
• Neurologic/psychiatric (e.g. haloperidol, methylphenidate, opioids, risperidone, TCAs)
• Drugs of abuse (e.g. alcohol, amphetamines, heroin, marijuana, methadone)
  1. Abbreviations: GnRH Gonadotropin-releasing hormone, GH Growth hormone, TCAs Tricyclic antidepressants.