Occasionally a male with chronic renal failure may develop gynecomastia following the start of effective therapy.
The patient usually has a history of:
(1) chronic renal failure with protein-calorie malnutrition
(2) suppression of pituitary gonadotrophin production and testicular function
Triggering events:
(1) initiation of regular hemodialysis
(2) refeeding syndrome associated with increased protein intake
Therapy can result in a surge of gonadotropin release and testicular function that may mimic puberty. This can result in a transient gynecomastia that resolves with continued renal and nutrition therapy.
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