Bilateral breast enlargement in a chronic alcoholic: do not miss Madelung's disease

Description

A 36-year-old man, a non-smoker, presented with painless and progressive enlargement of both breasts for the past 3 years. He had two biological children and had a long history of alcohol abuse (about 10 units/day for more than 10 years). He reported normal libido, no erectile dysfunction, normal spontaneous erections and no decrease in shaving frequency.

Physical examination revealed a masculine and well virilised man with a normal body mass index (BMI: 24.4 kg/m²) with central obesity (waist circumferences: 98 cm). Breast examination suggested lipomastia with a disc diameter of 0.5 cm bilaterally (figures 1 and 2). Both testes had normal consistency with a volume of 25 mL. Interestingly, the patient had multiple soft, painless masses distributed over the infra-axillary and supraclavicular areas, dorsocervical and interscapular regions (figures 3 and 4), suprasternal area (figure 5), and underneath the chin and occiput, without any definite...

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