Dr. Nagaraj
Diabetology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 42-year-old male with mast cell activation syndrome (MCAS). Approximately six months ago, I noticed that my left breast was enlarged with apparent gynecomastia. My doctor confirmed this, along with swelling in my left arm, which is larger than my right arm. I also have occasional severe pain in my left extremities (arm, shoulder, neck), intermittent aching pain or soreness in the breast tissue, and sensitivity around the nipple. Accompanying this pain and sensitivity, I have tinnitus, a feeling of fullness in my left ear, and the breast and ear symptoms seem to come together, and for that reason, I assume they are related. I have speculated that my lymph flow may be causing this something the cardiologist suggested but could not pursue because it is not her specialty, but I do not know what to think. I am worried something may be blocking my lymph, etc. I could be ignoring it to my detriment.
My doctor referred me to a cardiologist and a breast center. A mammogram and ultrasound revealed that I have gynecomastia in both breasts, much more prominent on the left side. Aside from an abnormal amount of breast tissue for a male, the doctor said she saw no abnormalities and no cancer indication. The cardiologist ordered a CT scan of my heart's greater vessels and did an ultrasound of my chest, and said there are no cardiovascular or vessel problems.
All doctors agreed that an H2 blocker antihistamine. For years, I have treated my mast cell activation disorder and discontinued it, replacing it with another H2 blocker, which is less likely to cause gynecomastia.
I am writing to get another opinion on the pain and sensitivity in the left breast. Does this typically occur as a symptom of gynecomastia? Or should it be a cause for concern? If it is cause for concern, what type of specialist should I pursue? I will speak soon with my doctor and ask her this question, but I was hoping to get an objective third-party opinion.
Hello,
Welcome to icliniq.com.
I understand your concern. Thanks for reaching out, and try to help you to my best, albeit remotely. The first thing is breast enlargement in males (gynecomastia) is usually a painless condition. It can be seen normally seen in obese individuals and certain medical conditions. Unless accompanied by a medical condition, it requires no intervention but treating the underlying cause. In normal individuals with no medical conditions, it is treated only for cosmetic reasons. Next, antihistamines (like Cimetidine) can cause breast enlargement in males on long term use.
Considering the involvement of ear (fullness), tinnitus, and intermittent pain around breast tissue (which we call dermatomal distribution), it makes me think of nerve involvement. However, I see no strong relation between them with breast enlargement in your case. I like to rule out high cervical lesions (in neck bones) first. Considering the complexity involved, a multidisciplinary approach would be a better option. I hope this helps. Take care.
Patient's Query
Hi doctor,
Thank you for your reply.
I was diagnosed at the age of 33 (nine years ago) with cervical spondylosis. I understand that it can cause pain in the upper extremities. Can nerve compression also cause breast tissue growth and pain? Or would the two be co-occurring but not related?
Hello,
Welcome back to icliniq.com.
Thanks for that. I was giving it a thought for a while now, wondering what could be the possibilities other than cervical lesions. As spondylosis is a chronic condition, it can still be the cause of your pain now.
Now, breast growth in males is due to hormonal imbalance. Nerve compressions do not cause breast enlargement. I am strongly suspecting pain and breast enlargement are coincidence in your case as you have a history supporting both of them (antihistamine and cervical lesion). I hope this helps. Take care. If you are satisfied with my answer, kindly provide feedback. You are free to reach out to me anytime concerning your health condition.
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