IGF1 and Pachydermoperiostosis: The presence of gynecomastia in this patient may be related to altered prostaglandin metabolism, which can influence local estrogen-androgen balance and peripheral aromatization. Similar reports suggest that secondary endocrine dysregulation involving the growth hormone-insulin-like growth factor-1 (GH-IGF-1) axis may occur in pachydermoperiostosis, and gynecomastia may represent a rare endocrine manifestation rather than a coincidental finding [3,8,9].