Gynecomastia results from the increased action of estrogen on the male breast tissue. The cirrhotic liver is unable to metabolize this hormone, which is found naturally in low levels in all males. This condition is considered benign, and when symmetric, no diagnostic workup is required.
Gynecomastia may alternatively be related to the diuretic spironolactone, commonly used for hypertension, acne or ascites. Enlarged, tender breasts should prompt the clinician to decrease doses of spironolactone or to switch to an alternative diuretic agent, like eplerenone (another aldosterone antagonist).