رجل عمره ٦١ سنة عنده فشل قلب، يأخذ سبيرونولاكتون ٥٠ ملغ منذ ٦ أشهر مع أدوية أخرى. البوتاسيوم ٤٫٨ والكرياتينين مستقر. يقول بحرج إن صدره صار متورماً ومؤلماً عند اللمس من الجهتين، بدون كتلة صلبة أو إفرازات. ما التفسير الأنسب؟

A 61-year-old man with heart failure has taken spironolactone 50 mg for 6 months with other drugs. Potassium 4.8, creatinine stable. He says, embarrassed, that both breasts have become swollen and tender, without a hard lump or discharge. What is the most fitting explanation?

1. Right heart failure needing a higher diuretic dose
2. A skin allergy to the drug needing an antihistamine
3. A known hormonal side effect of spironolactone
4. Breast cancer needing an urgent biopsy before anything else

Answer: C) A known hormonal side effect of spironolactone. Spironolactone has anti-androgen effects and can cause gynaecomastia. The prescriber is told and may switch to eplerenone, which causes it less.