Breast & Menstrual Disorders Flashcards
Is gynecomastia usually benign in males?
Yes!
what is first-line tx for gynecomastia?
watchful waiting
for gynecomastia, when would you avoid watchful waiting and initiate a work-up immediately, instead?
in cases when:
- -size is increasing rapidly
- -testicular concerns
if you have concerns about testicular size + gynecomastia, you should:
do an ultrasound
an increase in what hormone can cause gynecomastia?
estrogen
in order to have gynecomastia, what must be present?
an actual breast bud
what is pseudo-gynecomastia?
when there is just adipose tissue (fat) & no breast bud
what is gynecomastia?
proliferation of glandular tissue of male breast w/rubbery firm mass concentrically from the nipple
when does gynecomastia occur?
- -60-90% of newborns have transient gynecomastia
- -2nd onset at 10-12 yrs old (40% of boys have pubertal gynecomastia)
- -> peaks at 14 - -again in older men
what is peak age of pubertal gynecomastia?
14 yrs old
pubertal gynecomastia should resolve by when?
- -should resolve in 2 yrs
- -regresses in 18 mos
cause of gynecomastia?
- -increase in estrogen
- -decrease in androgen
- -> increase in free estrogens
name 4 pathological types of conditions that are associated w/gynecomastia:
1) neoplasms
2) Hypogonadism
3) Conditions that decrease androgen levels
4) Conditions that increase estrogen levels
name 2 pathologic neoplasms that are assoc. w/gynecomastia:
1) testicular
2) adrenal ectopic production of HCG
name 3 forms of Hypogonadism that are assoc. w/gynecomastia:
1) primary gonadal failure
2) Klinefelter’s
3) secondary hypogonadism
name 3 conditions that decrease androgen levels & are assoc. w/gynecomastia:
1) enzymatic defect of testosterone
2) androgen insensitivity syndromes
3) d/o’s of sexual differentiation:
- -ovotesticular d/o of sexual development (true hermaphrodism)
name 8 conditions that increase estrogen levels & are assoc. w/gynecomastia:
1) obesity
2) liver disease
3) starvation
4) renal disease
5) hyperthyroidism
6) excessive extraglandular aromatase activity
7) idiopathic
8) drugs
4 types of drugs w/estrogen-like effects (that are assoc. w/gynecomastia):
1) diethylstilbesterol
2) oral contraceptive pills
3) Digitalis
4) estrogen-containing cosmetics
11 types of drugs that inhibit testosterone action (and are assoc. w/gynecomastia):
1) Ketoconazole
2) Spirolactone
3) Cimetidine
4) Isoniazid
5) Captopril
6) Tricyclics
7) Antidepressant
8) Diazepam
9) Marijuana
10) phenothiazine
11) aripiprazole (Abilify) –> antipsychotics are notorious!
when would reassurance not be the proper tx for gynecomastia?
If:
- -does not resolve after 2 yrs
- -develops rapidly
medical management of gynecomastia?
1) Danazol (synthetic derivative of testosterone)
2) Clomiphene (anti-estrogen)
3) Tamoxifen (estrogen antagonist)
which drug is a synthetic derivative of testosterone?
Danazol
screening blood work for gynecomastia?
1) FSH
2) LH
3) HCG (Human chorionic gonadotropin hormone)
4) liver function tests
5) TSH
6) estradiol & testosterone
