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Gynaecomastia in association with phenytoin and zonisamide in a patient having a CYP2C subfamily mutation
  1. AKIO IKEDA
  1. Department of Brain Pathophysiology
  2. Department of Pediatrics
  3. Department of Pharmacy
  4. Department of Neurology
  5. Department of Brain Pathophysiology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto, 606, Japan
  1. Dr Akio Ikeda, Department of Brain Pathophysiology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto, 606, Japan. Telephone 0081 75 751 4346; fax 0081 75 751 3202; email akio{at}kuhp.kyoto-u.ac.jp
  1. HARUO HATTORI
  1. Department of Brain Pathophysiology
  2. Department of Pediatrics
  3. Department of Pharmacy
  4. Department of Neurology
  5. Department of Brain Pathophysiology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto, 606, Japan
  1. Dr Akio Ikeda, Department of Brain Pathophysiology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto, 606, Japan. Telephone 0081 75 751 4346; fax 0081 75 751 3202; email akio{at}kuhp.kyoto-u.ac.jp
  1. ATSUKO ODANI
  1. Department of Brain Pathophysiology
  2. Department of Pediatrics
  3. Department of Pharmacy
  4. Department of Neurology
  5. Department of Brain Pathophysiology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto, 606, Japan
  1. Dr Akio Ikeda, Department of Brain Pathophysiology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto, 606, Japan. Telephone 0081 75 751 4346; fax 0081 75 751 3202; email akio{at}kuhp.kyoto-u.ac.jp
  1. JUN KIMURA
  1. Department of Brain Pathophysiology
  2. Department of Pediatrics
  3. Department of Pharmacy
  4. Department of Neurology
  5. Department of Brain Pathophysiology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto, 606, Japan
  1. Dr Akio Ikeda, Department of Brain Pathophysiology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto, 606, Japan. Telephone 0081 75 751 4346; fax 0081 75 751 3202; email akio{at}kuhp.kyoto-u.ac.jp
  1. HIROSHI SHIBASAKI
  1. Department of Brain Pathophysiology
  2. Department of Pediatrics
  3. Department of Pharmacy
  4. Department of Neurology
  5. Department of Brain Pathophysiology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto, 606, Japan
  1. Dr Akio Ikeda, Department of Brain Pathophysiology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto, 606, Japan. Telephone 0081 75 751 4346; fax 0081 75 751 3202; email akio{at}kuhp.kyoto-u.ac.jp

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Anticonvulsant drugs can have various side effects on endocrine functions, such as impotence, hirsutism, infertility, and thyroid dysfunction. Gynaecomastia is caused by many types of drugs such as methyldopa, tricyclic antidepressant drugs, isoniazid, and spironolactone,1 but there have been only a few reports of gynaecomastia caused by anticonvulsant drugs, including phenytoin2 and zonisamide.3 We recently encountered a young man with partial seizures, who genetically had a heterozygous mutation of both CYP2C9 and CYP2C19,4normally responsible for biotransformation of phenytoin in the human liver microsomal P-450 system.5 He developed gynaecomastia after increasing the dose of phenytoin.

The patient was an 18 year old man with a diagnosis of left parietofrontal lobe epilepsy since the age of 2 years, until which time his developmental milestones were normal. He had complex partial seizures occurring at least once every day despite various anticonvulsant drugs of usually sufficient dose including clorazepate, phenytoin, and carbamazepine, and zonisamide since the age of 9 years, when he had an epilepsy surgery for a focal high intensity abnormality on T2 weighted MRI in the left parieto-occipital area.His …

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