Long-term use of which diuretic agent can result in gynaecomastia

POTASSIUM SPARING DIURETICS Aldosterone antagonist Spironolactone:- It is a steroid, chemically related to the mineralocoicoid aldosterone. Aldosterone penetrates the late DT and CD cells and acts by combining with an intracellular mineralocoicoid receptor (MR) -> induces the formation of 'aldosterone-induced proteins' (AIPs). The AIPs promote Na+ reabsorption by a number of mechanisms and K+ secretion. Spironolactone acts from the interstitial side of the tubular cell, combines with MR and inhibits the formation of AIPs in a competitive manner. Adverse effects:- The side effects are drowsiness, ataxia, mental confusion, epigastric distress and loose motions. Spironolactone interacts with progestin and androgen receptors as well. In addition, it may enhance testosterone clearance or its peripheral conversion to estradiol, producing dose and duration of treatment related hormonal side effects like gynaecomastia, erectile dysfunction or loss of libido in men, and breast tenderness or menstrual irregularities in women. Most serious is hyperkalaemia that may occur, especially if renal function is inadequate. Acidosis is a risk, paicularly in cirrhotics. Peptic ulcer may be aggravated; it is contraindicated in ulcer patients. Ref:- kd tripathi; pg num:-587,589