Gynaecomastia


DEFINITION
Differential diagnosis presented here, with some additional relevant information.
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INCIDENCE
See causes.
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AETIOLOGY

Physiological
Teenagers may have pubertal hypertrophy (80% resolve spontaneously).
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- cf senescent hypertrophy in older men.
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Inflammation

Cirrhosis.

EM

Hypogonadism and sieve.
Renal failure
Malnutrition.

Tumour

Testicular malignancies.

DPT

Alcohol, cannabis.
Digoxin, spironolactone, ACE inhibitors.
Estrogens.
Phenothiazines, theophylline.
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BIOLOGICAL BEHAVIOUR

Physiological
Teenage boys
Frequently bilateral
- though may be unilateral.
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MANIFESTATIONS

Physiological
May be painful

Signs
Smooth firm discoid mass evenly distributed beneath areolar.
Needs to be differentiated from fatty tissue - seen in fat people.
- should be little confusion with carcinoma, which rarely occurs in men.

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INVESTIGATIONS

1. Sample any dominant masses carefully.
- mammogram, USS, particularly if +ve hx
- FNA / core biopsy of palpable masses.
2. TFTs, LFTs, alpha-fetoprotein, Beta-HCG, prolactin
3. Scrotal ultrasound in young me; USS/CT abdo in older men for liver.

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MANAGEMENT

Physiological
Reassure; 75% improve in 2y without treatment
May pass unnoticed and regress in adulthood.
Discuss surgical option if cosmetic concern or fails to regress.

Older
Treat cause and operate if reqd
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