Updated: 1/11/2018

Gynecomastia

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Questions
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Evidence
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Topic
Introduction
  • Benign breast enlargement in males secondary to increased effective estrogen
    • can be increased production or decreased degradation
    • also result of decrease in androgens leaving estrogens unopposed
  • May occur naturally throughout male life
    • newborn
      • secondary to high maternal estrogen
    • puberty
    • elderly
      • secondary to androgen decrease
  • Associated conditions
    • cirrhosis
    • genetic diseases
      • Klinefelter syndrome
        • increased aromatizing activity of Leydig cells
        • high estrogen results in increased male breast cancer risk
      • testicular feminization
    • cancer
      • choriocarcinoma of testis
        • high production of hCG (an LH analogue)
    • drugs
      • estrogen
      • marijuana
      • flutamide
        • blocks androgen receptors
      • leuprolide
        • blocks androgen production
      • psychoactive drugs
      • "Some Drugs Create Awesome Knockers"
        • Spironolactone
          • block androgen receptors, displaces estrogen from SHBG
        • Digitalis
          • intrinsic estrogen activity
        • Cimetidine
        • Alcohol
        • Ketoconazole
          • displaces estrogen from SHBG

 

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Questions (1)

(M1.RP.14.24) A 14-year-old boy is accompanied by his mother to general pediatrics clinic for a routine visit. The boy has no complaints. He is doing well in school and has no medical illnesses. However, his mother reports that she is concerned about the growth in his chest. She states that over the past several months he has been developing what seem to be breasts. Vital signs are stable. Physical examination reveals the following in Figure A with the left chest slightly larger than the right chest. Both are soft to palpation and nontender. What is the next step in management?

QID: 105422
FIGURES:
1

Order serum testosterone

25%

(23/93)

2

Order serum estrogens

23%

(21/93)

3

Order a mammogram of both breasts

1%

(1/93)

4

Biopsy the left, larger breast

1%

(1/93)

5

Reassurance

46%

(43/93)

M 3 D

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Evidence (3)
EXPERT COMMENTS (16)
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