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Follow-Up of Gynecomastia among Haitian Males

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

  1. CDC. Gynecomastia in Haitians--Puerto Rico, Florida, Texas, New York. MMWR 1982;31:205-6.

  2. 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

  3. Carlson, HE. Medical intelligence: current concepts, gynecomastia. N Engl J Med 1980;303:795-9. *Wilcoxon signed rank test

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