Gynecomastia in Haitians -- Puerto Rico, Florida, Texas, New York

Since the fall of 1981, gynecomastia has been occurring in Haitian men located in the Immigration and Naturalization Service's (INS) Service Processing Centers. Although no cause has been found, the condition appears to be spontaneously resolving.

In November 1981, several Haitian men at the INS Fort Allen Service Processing Center, Puerto Rico, presented at the Public Health Service Clinic complaining of breast enlargement. Because of this unusual occurrence of gynecomastia, CDC was asked on November 30, to assist in an epidemiologic investigation.

Of 540 male Haitians 18-50 years old examined, 77 (14.3%) had gynecomastia--defined as a palpable, firm, discoid, subareolar, unilateral or bilateral breast mass. Of these 77 persons, 11 had noted the problem in Haiti, and 5 in Miami. Of 187 non-Haitian, male employees of the Center examined, 6 (3.2%) had gynecomastia, and of these, 2 had the problem before the facility opened. The difference in prevalence between Haitians and Center employees was statistically significant (p 0.0005).

After the disorder was recognized in Fort Allen, cases of gynecomastia were found in Haitians in other INS facilities, including the INS Service Processing Center, El Paso, Texas, and the Krome North Service Processing Center, Miami, Florida. Because all Haitians entering the United States and processed by INS are first processed at Krome, further investigation was continued there. On January 4, 1982, examination of the entire Haitian male population at Krome for gynecomastia was completed. Of 522 male Haitians, 52 (10.0%) had gynecomastia. Of these 52, 2 reported to have had the disorder before leaving Haiti. One of 10 non-Haitian aliens processed at Krome also reported the recent development of gynecomastia.

A case-control study was done at Fort Allen and Krome during December and January that consisted of a questionnaire and a physical examination that included examination of the skin, hair, and genitalia and palpation of the thyroid and liver. Preliminary analysis showed no statistically significant differences between cases and controls.

On March 22, 1982, 49 of the 53 patients examined in January were reexamined; 21 patients (43%) had no evidence of gynecomastia, and 15 had a decrease in breast size. Therefore, 36/49 (74%) of the originally detected cases have had either total or partial remission. Most of these 36 occurred among Haitians who arrived by late September 1981.

In March 1982, 18 new cases were detected in Haitian men at Krome who had had no evidence of gynecomastia when examined in January. On March 22, the prevalence at Krome was 46/528 (8.7%).

Surveillance continues for new cases at facilities where Haitians are being detained. Recently, active surveillance detected cases in Brooklyn, New York (4/28 persons screened, 14%) and in Otisville, New York (17/97 persons screened, 18%). No new cases have been reported at Fort Allen.

Analysis of serum specimens from participants in the case-control study for prolactin, luteinizing hormone, testosterone, estradiol, blood-urea-nitrogen, creatinine, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, bilirubin, creatine phosphokinase, lactate dehydrogenase, and calcium has not been completed. Screening of urine specimens for drugs that act on the central nervous system and have been associated with gynecomastia was negative (1). Milk and eggs obtained in December and January from Fort Allen and Krome were tested for diethylstilbesterol and were negative. In addition, other food items, water, and other environmental agents are being tested for the presence of estrogen or estrogen-like compounds. Reported by PHS Chief Medical Officers, Fort Allen (Puerto Rico) and Krome North (Miami, Florida) Immigration and Naturalization Service's Service Processing Centers; Center for Environmental Health, Epidemiology Program Office, Quarantine Div, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Gynecomastia has been now detected at 5 facilities where Haitians are being detained. Although all male Haitains processed by INS were initially processed at Krome, several of the men with gynecomastia detected at other facilities had been at Krome for less than 2 weeks. Neither the incidence nor the prevalence of gynecomastia in Haiti is known. Although some Haitian entrants may have had gynecomastia before arriving in the United States, there is no question that gynecomastia has developed in Haitian men after arrival.

The epidemiologic findings at Krome show that the cases of gynecomastia there are spontaneously resolving and that the development and resolution of the process appears related to date of arrival. Two possible hypotheses to explain these cases of gynecomastia are 1) that the diet of Haitians improved greatly after they arrived in the United States causing refeeding gynecomastia (1) or 2) that the affected men were exposed to an estrogen or estrogen-like substance during processing at Krome.

References

1. Carlson, HE. Medical intelligence, current concepts, gynecomastia. N Engl J Med 1980;303:795-9.

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