Gynaecomastia

Question 1

What is Gynaecomastia?

Answer 1

When males develop breast tissue due to an imbalanced ratio of oestrogen and androgen activity

Question 2

What is the pathophysiology of gynaecomastia?

Answer 2

Due to increased oestrogen compared to testosterone

Question 3

What are some causes of gynaecomastia?

Answer 3

Physiological in puberty, Lack of testosterone (klinefelters, androgen insensitivity, testicular atrophy, renal disease) increased oestrogen (liver disease, hyperthyroidism, obesity, adrenal tumours, testicular subtypes) medications (digoxin, metrodazole, spirinolactone, chemotherapy etc) idiopathic

Question 4

What are the clinical features of gynaecomastia?

Answer 4

rubbery or firm mass that starts from underneath the nipple and spreads over the breast region, make sure to ask about potential causes and comorbidities

Question 5

What are the main differentials to gynaecomastia?

Answer 5

pseudogynaecomastia, which is adipose tissue in the breast due to being overweight- can punch to see if there is obvious disc of breast tissue

Question 6

What investigations can be done for Gynaecomastia?

Answer 6

tests only needed if a cause is unknown, triple assessment, liver and renal function tests, hormone profile

Question 7

What would a high LH and low testosterone show?

Answer 7

testicular failure

Question 8

What would low LH and low testosterone show?

Answer 8

increased oestrogen

Question 9

What would high LH and high testosterone show?

Answer 9

androgen resistance or gonadotrophin secreting malignancy

Question 10

What is the management for Gynaecomastia?

Answer 10

depends on the underlying cause, reassurance, tamoxifen can reliviate symptoms especially tenderness, surgery if fibrosis extensive