gynaecomastia

Question 1

what is gynaecomastia?

Answer 1

a condition where males develop breast tissue due to an imbalance of oestrogen and androgen activity.

Question 2

what is physiological gynaecomastia?

Answer 2

usually occurs in adolescence, resulting from delayed testosterone surge relative to oestrogen at puberty.

Question 3

what is pathological gynaecomastia?

Answer 3

causes can include

• lack of testosterone e.g Klinefelters syndrome, androgen insensitivity, testicular atrophy or renal disease
• increased oestrogen levels e.g liver disease, hyperthyroidism, obesity, adrenal tumours or testicular subtypes.
• medication
• idiopathic

Question 4

what are the clinical features of gynaecomastia?

Answer 4

• rubbery or firm mass
• starts underneath the nipple
• asses for breast malignancy
• do a testicular examination

Question 5

what is a differential for gynaecomastia?

Answer 5

pseudogynaecomastia, which is adipose tissue in the breast region associated with being overweight.

Question 6

what investigations can be done for gynaecomastia?

Answer 6

do tests if cause is unknown
in cases of suspected malignancy, do a triple assessment

if unknown

• LFT, U&E checked
• hormone profile

check levels of leutenising hormone and testosterone

• LH high and testosterone low = testicular failure
• LH low and testosterone low = increased oestrogen
• LH high and testosterone high = androgen resistance or gonadotrophin secreting malignancy.