Gynaecomastia

Question 1

Define gynaecomastia

Answer 1

• Enlargement of breast tissue (usually male)

- >2cm of palpable firm subareolar gland and ductal breast tissue

Question 2

What is the epidemiology of gynaecomastia?

Answer 2

Presents at some stage in 1/3 of men

Only 1% of gynaecomastia = breast carcinoma

Question 3

What is the aetiology of gynaecomastia?

Answer 3

PHYSIOLOGICAL
Puberty = 25%

DRUGS = 10-20%

• Spironolactone
• Cimetidine
• Digoxin
• Androgens
• Anti-oestrogens

DISEASE
Cirrhosis/malnutrition = 8%
Hypogonadism
Testicular tumours
Hyperthyroidism
Renal disease

OTHER
Idiopathic = 25%

Question 4

What might as well be seen in examination?

Answer 4

LIVER & RENAL DISEASE

• Palmer erythema
• Bruising
• Spider naevi
• Hepatomegaly

LACK OF TESTOSTERONE

• Hairless
• Shiny skin
• Testicular size/mass
• Tenor of voice

OTHER

• Hyperthyroid signs
• Cushing Disease signs

Question 5

How does gynaecomastia appear on imaging

Answer 5

US
-Flame-shaped hypoechoic (dark grey) mass behind nipple

MAMMOGRAM
Ranges from:
-Flame shaped density behind breast
-Florid diffuse increase in breast intensity

Question 6

How is gynaecomastia managed?

Answer 6

Further investigations to rule out carcinoma (imaging + biopsy)

Investigate pathological causes

• Liver and renal function
• Prolactin
• Alpha-fetoprotein (testicular/liver cancer)
• Beta-HCG (testicular carcinoma)

Stop any anabolic steroids