Gynaecomastia Flashcards
what is it
enlargement of breast tissue in males
What hormones cause gynaecomastia
Raised oestrogen and lower androgen levels
Raised prolactin
What medications can lead to gynaecomastia and how
Dopamine antagonists inhibit dopamine. Dopamine normally inhibits prolactin so less dopamine means more prolactin
Examples - antipsychotic meds
What are causes of gynaecomastia related to increased oestrogen?
Idiopathic
Physiological in adolescents due to higher oestrogen levels in puberty
Obesity - aromatase found in adipose tissue converts androgen to oestrogen
Testicular cancer - in particular LEYDIG cell tumours
Liver cirrhosis and faiolure
Hyperthyroidism
hCG secreting tumour - small cell lung cancer
What additional exam should be performed in those with gynaecomastia?
Testicular examination to look for Leydig cell tumour
What are causes related to reduced testosterone?
Testosterone deficiency in older age
hypothalamus or pituitary conditions that reduce LH and FSH
Klinefelter syndrome
Orchitis
Testicular damage
What other medications can cause gynaecomastia?
Anabolic steroids - raise oestrogen
Antipsychotics - raise prolactin
Digoxin - stimulates oestrogen receptors
Spironolactone
GnRH agonists
Opiates
Marijuana
Alcohol
How do gynaecomastia and pseudogynaecomastia differ?
On palpation in gynaecomastia there will be firm tissue behind the areola
In obesity - soft and evenly distributed tissue
What blood tests might you consider
YEs
LFTs
TFTs
Testosterone
Sex hormone binding globulin
Oestrogen
Prolactin
LH and FSH
Alpha fetoprotein and beta hCG for testicular cancer
Genetic karyotyping
What imaging would you consider?
Breast USS
Mammogram
Biopsy
Testicular USS
CXR
What are treatment options in problematic cases?
Tamixofen
Surgery
