Plasma phthalate levels in pubertal gynecomastia

Pediatrics. 2010 Jan;125(1):e122-9. doi: 10.1542/peds.2009-0724. Epub 2009 Dec 14.


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 Doğramaci 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 microg/mL, respectively [odds ratio: 2.77 (95% confidence interval: 1.48-5.21)]; MEHP, 3.19 +/- 1.41 and 1.37 +/- 0.36 microg/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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Chemical Analysis
  • Case-Control Studies
  • Child
  • Diethylhexyl Phthalate / analogs & derivatives*
  • Diethylhexyl Phthalate / blood*
  • Diethylhexyl Phthalate / chemistry
  • Environmental Exposure / adverse effects*
  • Gynecomastia / blood
  • Gynecomastia / epidemiology
  • Gynecomastia / etiology*
  • Humans
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Phthalic Acids / blood
  • Phthalic Acids / chemistry
  • Probability
  • Puberty / blood
  • Puberty / physiology
  • Radioimmunoassay
  • Reference Values
  • Risk Assessment
  • Tandem Mass Spectrometry
  • Turkey


  • Phthalic Acids
  • phthalic acid
  • Diethylhexyl Phthalate
  • mono-(2-ethylhexyl)phthalate