Spironolactone-Induced Bilateral Gynecomastia in a Patient With Comorbid Conditions

Gynecomastia is a benign proliferation of male breast glandular tissue caused by an imbalance between estrogen and androgen activity. Spironolactone, a potassium-sparing diuretic commonly prescribed for edema and ascites in chronic liver disease, is a recognized cause of drug-induced gynecomastia because of its antiandrogenic effects. We report the case of a man in his 50s with chronic liver disease and type 2 diabetes mellitus who presented with bilateral breast swelling and mild tenderness of one month's duration. Clinical examination revealed bilateral soft glandular enlargement without nipple discharge, a hard mass, or axillary lymphadenopathy. Breast ultrasonography demonstrated diffuse fibroglandular proliferation with subareolar thickening consistent with bilateral gynecomastia. Laboratory investigations showed mildly reduced serum testosterone with relative estrogen predominance, while prolactin, luteinizing hormone, follicle-stimulating hormone, and thyroid function tests were within normal limits. Chronic liver disease likely contributed to hormonal imbalance through impaired estrogen metabolism and altered sex hormone regulation, thereby increasing susceptibility to spironolactone-induced gynecomastia. Spironolactone therapy was discontinued, and conservative management with clinical monitoring was advised. The patient showed gradual symptomatic improvement during follow-up. This case highlights the importance of recognizing medication-induced endocrine adverse effects, particularly in patients with chronic systemic illnesses such as hepatic dysfunction.