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January 3, 1977

Roentgenographic Aspects of Narcotic Addiction

JAMA. 1977;237(1):24. doi:10.1001/jama.1977.03270280026003

To the Editor.—  The article by Dr Stern (236:963, 1976) entitled "Roentgenographic Aspects of Narcotic Addiction" states that the observation of gynecomastia in an addict's chest roentgenogram may be a clue to the diagnosis of hepatitis.Although gynecomastia is widely recognized as an occasional physical sign in patients with cirrhosis, it is certainly not frequent in the type of acute hepatitis seen in drug addicts. Inability of the diseased liver to deactivate circulating estrogens would not be an acceptable pathogenetic mechanism for gynecomastia in recently acquired hepatitis, and there is some doubt, too, that it is the real explanation for gynecomastia in cirrhotic patients.The incidence of acute alcoholism and drug addiction is very high in Jersey City. We have seen many patients with hepatitis resulting from heroin use in the past five years, but I cannot recall seeing gynecomastia in the early evolutionary stage of this disease.The occurrence