Gynaecomastia

Question 1

List 5 common causes of gynaecomastia?

Answer 1

Spironolactone
Bronchogenic carcinoma
Cimetidine (OTC H2 receptor blocker for reflux)
Thyrotoxicosis
digoxin and antiprostate agents
Hypogonadism
Chronic liver disease
Tumour testicular, adrenal.

Question 2

Describe how to examine for gynaecomastia?

Answer 2

Supine with hand behind head. Examiner using thumb and index finger to feel for rubbery to firm concentric tissue under areola complex.

Question 3

What is pseudogynaecomastia?

Answer 3

Excess adipose tissue

Question 4

List 8 causes of gynaecosmastia?

Answer 4

Persistent pubertal gynecomastia – 25 percent
•Drugs – 10 to 25 percent (table 2)
•No detectable abnormality – 25 percent
•Cirrhosis or malnutrition – 8 percent
•Male hypogonadism – Primary (8 percent), secondary (2 percent) ie Klinfelters. 
•Testicular tumors – 3 percent
•Hyperthyroidism – 1.5 percent
•Chronic renal insufficiency – 1 percent

Question 5

When are biochemical tests indicated?

Answer 5

When the history does suggest a typical underlying cause
Rapid onset - may be suggestive hormonal secreting cancer.
Consider morning testosterone (note 2-5% of elderly men have hypogonadism.