A 17-year-old boy being treated for nephrotic syndrome develops bilateral, tender gynaecomastia over 3 months. Testicular examination and serum beta-hCG are normal. Which of his medications is the most likely cause?
- A Frusemide
- B Spironolactone ✓
- C Enalapril
- D Atenolol
Correct answer: B. Spironolactone
Explanation
Spironolactone is a well-established cause of drug-induced gynaecomastia through antiandrogenic effects at the androgen receptor and peripheral testosterone-to-estradiol conversion. Other recognised offenders include cimetidine, digoxin, ketoconazole, estrogens, and marijuana. Frusemide, enalapril, and atenolol are commonly co-prescribed in these patients but are not linked to gynaecomastia, which is what makes them effective homogeneous distractors here.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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