The following account updates the recent report of gynecomastia
among Haitian male entrants located at the Immigration and
Naturalization Service's (INS) Service Processing Centers (1).
Current
findings continue to indicate a correlation between the date of
entrant arrival and spontaneous resolution of gynecomastia. The
prevalence of gynecomastia at the INS Fort Allen Service Processing
Center, Puerto Rico, has decreased from 77 (14.3%) of 540 examined
in
December, 1981, to 47/508 (9.3%) in May 1982.
On May 11, 1982, 66 of the 77 Haitian males with gynecomastia
detected at Fort Allen in early December 198l were re-examined; 46
patients (69.7%) no longer had evidence of gynecomastia, and six
had
decreased breast size. Therefore, of the originally detected
cases,
52/66 (78.8%) have either totally or partially remitted. Most of
these cases occurred among Haitians who had arrived in the United
States by late August 1981. In addition, 10 of 12 Haitian males
with
gynecomastia detected at Fort Allen after their transfer from the
El
Paso, Texas, and Otisville, New York, Service Processing Centers
between late December and early March were examined on May 11; nine
(90%) no longer had evidence of gynecomastia.
Twenty-one new cases were detected at Fort Allen among Haitian
males who had had no evidence of gynecomastia when examined in
December. Of the 52 Haitian males transferred to Ft. Allen from El
Paso and Otisville, six (11.5%) now have gynecomastia.
Analysis of serum specimens from participants in the
case-control
study at Fort Allen and at Krome North Service Processing Center,
Miami, Florida, (1) for prolactin, luteinizing hormone,
testosterone,
estradiol, blood-urea-nitrogen, creatinine, serum glutamic
oxaloacetic
transaminase, serum glutamic pyruvic transaminase, bilirubin,
creatinine phosphokinase, lactic dehydrogenase, and calcium showed
no
statistically significant differences between cases and controls.
Additional analysis of sera from cases and controls at Krome for
free
testosterone, free estradiol, sex hormone binding globulin, and
follicle stimulating hormone showed no statistically significant
differences. However, the ratio of free testosterone to free
estradiol (FTE/Fe((2))) was lower in cases than in controls, p =
0.051.* Analysis of the Krome drinking water revealed no estrogen
or
estrogen-like contaminants.
Reported by PHS Chief Medical Officers, Fort Allen (Puerto Rico)
and
Krome North (Miami, Florida) Immigration and Naturalization Svc's
Service Processing Centers; Center for Environmental Health,
Epidemiology Program Office, Quarantine Div, Center for Prevention
Svcs, Family Planning Div, Center for Health Promotion and
Education,
CDC.
Editorial Note
Editorial Note: The epidemiologic findings at Fort Allen
corroborate
those at Krome (1), which showed that the cases of gynecomastia are
spontaneously resolving and that the development and resolution of
the
process appear related to date of arrival. The lower FTE/Fe((2))
for
cases, as compared with controls, indicates a disturbance in the
androgen-to-estrogen ratio; the development of gynecomastia is
thought
to be related to a decrease in this ratio (2,3). Two possible
hypotheses for the cause of the gynecomastia remain: 1) a greatly
improved diet for Haitians after arrival in the United States or 2)
an
exposure to an estrogen or estrogen-like substance during
processing
at Krome. Investigations are continuing.
References
CDC. Gynecomastia in Haitians--Puerto Rico, Florida, Texas, New
York. MMWR 1982;31:205-6.
Emerson K, Wilson JD. Diseases of the breast and of milk
formation. In: Isselbacker KJ, Adams RD, Braunwald E,
Petersdorf
RG, Wilson JD. Harrison's textbook of medicine, 9th ed. New
York:
McGraw Hill, 1980:1787-94
Carlson, HE. Medical intelligence: current concepts,
gynecomastia. N Engl J Med 1980;303:795-9.
*Wilcoxon signed rank test
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