The authors describe gynecomastia in a man with coronary artery disease with heart failure with reduced ejection fraction and prior coronary-artery bypass grafting. After ruling out hypogonadism, liver disease, malignancy, and hyperthyroidism, the patient’s spironolactone was suspected to be the culprit at large. Clinicians should know that spironolactone-induced gynecomastia is generally dose-dependent and can occur months to years after starting therapy. Stopping spironolactone can reverse gynecomastia, but not if it’s too advanced, as in this patient.
Comment
The authors describe gynecomastia in a man with coronary artery disease with heart failure with reduced ejection fraction and prior coronary-artery bypass grafting. After ruling out hypogonadism, liver disease, malignancy, and hyperthyroidism, the patient’s spironolactone was suspected to be the culprit at large. Clinicians should know that spironolactone-induced gynecomastia is generally dose-dependent and can occur months to years after starting therapy. Stopping spironolactone can reverse gynecomastia, but not if it’s too advanced, as in this patient.