Correlation between gynecomastia and endocrine regulation in patients with metabolic dysfunction-associated fatty liver disease: A cross-sectional study

Ming-Huang Zhang; Ning Meng; Kang-Hui Zhang; Jun-Kang Yu; Chen-Hao Huang; Shu Yang; Ding-Yi Zhu

doi:10.4254/wjh.v17.i6.108096

Correlation between gynecomastia and endocrine regulation in patients with metabolic dysfunction-associated fatty liver disease: A cross-sectional study

World J Hepatol. 2025 Jun 27;17(6):108096. doi: 10.4254/wjh.v17.i6.108096.

Authors

Ming-Huang Zhang¹, Ning Meng², Kang-Hui Zhang¹, Jun-Kang Yu¹, Chen-Hao Huang¹, Shu Yang¹, Ding-Yi Zhu¹

Affiliations

¹ Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China.
² Department of Thyroid and Breast Surgery, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China. mengning0894@126.com.

Abstract

Background: Metabolic dysfunction-associated fatty liver disease (MASLD) is a chronic liver disease characterized by hepatocellular steatosis, which is closely related to metabolic syndrome, with annually increasing morbidity in recent years. Gynecomastia (GYN), an abnormal proliferation of breast tissue in males, is common in males with sex hormone imbalance. Currently, there is insufficient research on the morbidity of GYN and its correlation among MASLD patients.

Aim: To investigate the prevalence of GYN and its associated clinical features in patients with MASLD and determine the prevalence of GYN in patients with MASLD and analyze the predictive effect of sex hormones on GYN using receiver operating characteristic (ROC) curves.

Methods: A cross-sectional study was conducted in a tertiary care hospital. Among them, 997 patients met the inclusion criteria and underwent breast ultrasonography to determine the presence of GYN. Anthropometric data, laboratory test data [estradiol (E2), androgens, liver function, glucose, lipids, low-density lipoprotein, high-density lipoprotein, creatinine, and uric acid, etc.], as well as information on medical history, severity of fatty liver (mild, moderate, and severe), and duration of the disease were collected. Package for the Social Sciences version 27 and R software (version 4.3.1) were used for data analysis.

Results: The prevalence of GYN increased with the severity of fatty liver (27.6% for mild, 33.5% for moderate, and 58% for severe, P < 0.001); compared with non-GYN patients, GYN patients were older (54.11 ± 9.71 years vs 47.89 ± 9.92 years, P < 0.001), with significantly higher E2 levels, higher estrogen to androgen ratio (P < 0.001) and significantly lower androgen levels (P < 0.001). In ROC curve analysis, the combined model of testosterone and E2 had a high diagnostic value in predicting GYN in MASLD patients, surpassing a single indicator.

Conclusion: The presence of GYN may suggest more severe metabolic abnormalities in patients with MASLD. Therefore, early recognition of GYN may be crucial for early intervention in metabolic syndrome and endocrine abnormalities in patients with MASLD.

Keywords: Gynecomastia; Metabolic dysfunction-associated fatty liver disease; Metabolic syndrome; Receiver operating characteristic curve; Sex hormones.