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Published online December 14, 2009
PEDIATRICS Vol. 125 No. 1 January 2010, pp. e122-e129 (doi:10.1542/peds.2009-0724)
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ARTICLE

Plasma Phthalate Levels in Pubertal Gynecomastia

Erdem Durmaz, MDa, Elif N. Özmert, MD, PhDa, Pinar Erkekoglu, PhDb, Belma Giray, PhDb, Orhan Derman, MDa, Filiz Hincal, PhDb, Kadriye Yurdakök, MDa

Departments of a Pediatrics
b Toxicology, Hacettepe University, Ankara, Turkey

OBJECTIVE: Several untoward health effects of phthalates, which are a group of industrial chemicals with many commercial uses including personal-care products and plastic materials, have been defined. The most commonly used, di-(2-ethylhexyl)-phthalate (DEHP), is known to have antiandrogenic or estrogenic effects or both. Mono-(2-ethylhexyl)-phthalate (MEHP) is the main metabolite of DEHP. In this study, we aimed to determine the plasma DEHP and MEHP levels in pubertal gynecomastia cases.

PATIENTS AND METHODS: The study group comprised 40 newly diagnosed pubertal gynecomastia cases who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital. The control group comprised 21 age-matched children without gynecomastia or other endocrinologic disorder. Plasma DEHP and MEHP levels were measured by using high-performance liquid chromatography. Serum hormone levels were determined in some pubertal gynecomastia cases according to the physician's evaluation.

RESULTS: Plasma DEHP and MEHP levels were found to be statistically significantly higher in the pubertal gynecomastia group compared with the control group (P < .001) (DEHP, 4.66 ± 1.58 and 3.09 ± 0.90 µg/mL, respectively [odds ratio: 2.77 (95% confidence interval: 1.48–5.21)]; MEHP, 3.19 ± 1.41 and 1.37 ± 0.36 µg/mL [odds ratio: 24.76 (95% confidence interval: 3.5–172.6)]). There was a statistically significant correlation between plasma DEHP and MEHP levels (r: 0.58; P < .001). In the pubertal gynecomastia group, no correlation could be determined between plasma DEHP and MEHP levels and any of the hormone levels.

CONCLUSIONS: DEHP, which has antiandrogenic or estrogenic effects, may be an etiologic factor in pubertal gynecomastia. These results may pioneer larger-scale studies on the etiologic role of DEHP in pubertal gynecomastia.

Key Words: phthalate • di-(2-ethylhexyl)-phthalate • mono-(2-ethylhexyl)-phthalate • endocrine disrupter • puberty • gynecomastia

Abbreviations: DEHP—di-(2-ethylhexyl)-phthalate • MEHP—mono-(2-ethylhexyl)-phthalate • SPL—stretched penis length • HPLC—high-performance liquid chromatography • LH—luteinizing hormone • FSH—follicle-stimulating hormone • FT3—free triiodothyronine • FT4—free thyroxine • SHBG—sex hormone-binding globulin • DHEA-S—dehydroepiandrosterone sulfate

Accepted Jul 18, 2009.


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Phthalate Biomarkers in Pediatric Research
Mary S. Wolff, et al.
Pediatrics Online, 22 Jun 2010 [Full text]