International Case Reports Journal (ISSN: 2770-9647) (DOI: 10.5281) is an online peer reviewed international mega journal purely dedicated to publish genuine and academically valuable case reports that enrich the pre-existing knowledge in the field of medicine. We aim to publish best quality case reports and build a world-class platform for latest information on a specific topic, with contributions from leading experts. International Case Reports Journal (ISSN: 2770-9647) is useful to stay informed on the spectrum of health problems encountered in clinical practice, quality, patient safety, and healthcare systems issues within the scope of the journal. We differ from other journals by keeping belief in contributing and sharing medical knowledge by using case reports to disseminate best clinical practice.
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Case reports Journal

International Case Reports Journal (ISSN: 2770-9647)

International Case Reports Journal (ISSN: 2770-9647) (DOI: 10.5281) is an open access international journal

Case Report
An 84 year old male a known case of hypertension, Coronary artery disease-Single vessel disease, Post PTCA to RCA was on dual antiplatelets (Ecosprin and clopidogrel), statins, telmisartan and Nebivolol 2 mg once a day. He presented in opd with complaints of swelling ion bilateral breasts for few months (Figure 1). Endocrinology and surgeon&#39;s consultation were taken. USG of bilateral breast bilateral subareolar hypoechoic area with finger like projections measuring 12 mm × 5 mm on right side and 11 mm × 6 mm on left side suggestive of gynaecomastia (Figure 2). HIs FSH, LH and TSH, LFT and KFT&#39;S were within normal limits. Patient was not on any other drugs like spironolactone, digoxin which can also cause similar symptoms. His USG abdomen was unremarkable. Gynaecomastia was thought to be due to Nebivolol. Nebivolol was stopped gradually in a span of 2-3 months gynaecomastia had completely regressed.
Discussion
Gynecomastia is characterized by enlargement of the male breast, caused by glandular proliferation and fat deposition. Although the exact pathogenesis of gynecomastia is unknown, it is likely due to a hormonal imbalance between estrogens and androgens. The causes of gynecomastia can be physiologic, familial, pathologic, drug-induced or, in many cases, idiopathic. Side effects of drugs play a substantial role in the etiology of gynecomastia.
Many cardiovascular drugs in clinical practice causing gynaecomastia like Angiotensin-converting enzyme inhibitors, spironolactone, digoxin, amiodarone, verapamil, diltiazem, and nifedipine, has been reported in literature.
Medication-induced gynecomastia comprises of 10% to 20% of all gynaecomastia. Nebivolol is a third generation beta-1 selective blocker commonly used for l hypertension and systolic heart failure. Only few case reports of Nebivolol induced gynecomastia has been reported in literature as an adverse effect (Nermin Bayer et al., J Pharmacol Pharmacother 2015, July-Sep). No case report has been found in Indian subcontinent.

Nebivolol Induced Gynecomastia

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