Breast & Menstrual Disorders

Question 1

Is gynecomastia usually benign in males?

Answer 1

Yes!

Question 2

what is first-line tx for gynecomastia?

Answer 2

watchful waiting

Question 3

for gynecomastia, when would you avoid watchful waiting and initiate a work-up immediately, instead?

Answer 3

in cases when:

• -size is increasing rapidly
• -testicular concerns

Question 4

if you have concerns about testicular size + gynecomastia, you should:

Answer 4

do an ultrasound

Question 5

an increase in what hormone can cause gynecomastia?

Answer 5

estrogen

Question 6

in order to have gynecomastia, what must be present?

Answer 6

an actual breast bud

Question 7

what is pseudo-gynecomastia?

Answer 7

when there is just adipose tissue (fat) & no breast bud

Question 8

what is gynecomastia?

Answer 8

proliferation of glandular tissue of male breast w/rubbery firm mass concentrically from the nipple

Question 9

when does gynecomastia occur?

Answer 9

• -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

Question 10

what is peak age of pubertal gynecomastia?

Answer 10

14 yrs old

Question 11

pubertal gynecomastia should resolve by when?

Answer 11

• -should resolve in 2 yrs

- -regresses in 18 mos

Question 12

cause of gynecomastia?

Answer 12

• -increase in estrogen
• -decrease in androgen
  - -> increase in free estrogens

Question 13

name 4 pathological types of conditions that are associated w/gynecomastia:

Answer 13

1) neoplasms
2) Hypogonadism
3) Conditions that decrease androgen levels
4) Conditions that increase estrogen levels

Question 14

name 2 pathologic neoplasms that are assoc. w/gynecomastia:

Answer 14

1) testicular

2) adrenal ectopic production of HCG

Question 15

name 3 forms of Hypogonadism that are assoc. w/gynecomastia:

Answer 15

1) primary gonadal failure
2) Klinefelter’s
3) secondary hypogonadism

Question 16

name 3 conditions that decrease androgen levels & are assoc. w/gynecomastia:

Answer 16

1) enzymatic defect of testosterone
2) androgen insensitivity syndromes
3) d/o’s of sexual differentiation:
- -ovotesticular d/o of sexual development (true hermaphrodism)

Question 17

name 8 conditions that increase estrogen levels & are assoc. w/gynecomastia:

Answer 17

1) obesity
2) liver disease
3) starvation
4) renal disease
5) hyperthyroidism
6) excessive extraglandular aromatase activity
7) idiopathic
8) drugs

Question 18

4 types of drugs w/estrogen-like effects (that are assoc. w/gynecomastia):

Answer 18

1) diethylstilbesterol
2) oral contraceptive pills
3) Digitalis
4) estrogen-containing cosmetics

Question 19

11 types of drugs that inhibit testosterone action (and are assoc. w/gynecomastia):

Answer 19

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!

Question 20

when would reassurance not be the proper tx for gynecomastia?

Answer 20

If:

• -does not resolve after 2 yrs
• -develops rapidly

Question 21

medical management of gynecomastia?

Answer 21

1) Danazol (synthetic derivative of testosterone)
2) Clomiphene (anti-estrogen)
3) Tamoxifen (estrogen antagonist)

Question 22

which drug is a synthetic derivative of testosterone?

Answer 22

Danazol

Question 23

screening blood work for gynecomastia?

Answer 23

1) FSH
2) LH
3) HCG (Human chorionic gonadotropin hormone)
4) liver function tests
5) TSH
6) estradiol & testosterone