Gynaecomastia, Galactorrhoea, Phaeochromocytoma Flashcards
Define gynaecomastia?
refers to the enlargement of the glandular breast tissue in males.
Causes of gynaecomastia?
High oestrogen
Low testosterone
Obesity
Testicular tumour
Hyperthyroidism
Liver disease
Marijuana
Medication (e.g. digoxin, spironolactone, antipsychotics, anabolic steroids)
Presentation of gynaecomastia?
abnormal breast tissue in men
significant psychological impact
may be tender
may have a rubbery or firm feel
IVx/diagnosis of gynaecomastia?
breast tissue -firm, palpable, sub-areolar >2cm
- TFTs
- LFTs
- U&Es
- hCG
- prolactin, LH, FSH
- testosterone
- estradiol
- USS -breast, testes
Management of gynaecomastia?
- Refer if red flags -unilateral, hard/irregular tissue, fixed mass, pain, axillary lymphadenopathy
- stop causative drugs
- treat underlying cause
- Tamoxifen
Define Galactorrhoea?
refers to breast milk production not associated to pregnancy or breastfeeding.
Causes of galactorrhoea?
- prolactinoma (hormone-secreting pituitary tumours)
- hypothyroidism
- PCOS
- Cushing’s
- acromegaly
- medication that increase prolactin levels (e.g. dopamine antagonists)
Presentation of galactorrhoea?
- non-obstetric lactation
- reduced libido
- erectile dysfunction in men
- gynaecomastia
- amenorrhoea
IVx/diagnosis of galactorrhoea?
- LFTs
- TFTs
- U&Es
- hCG
- prolactin
- MRI
Management of galactorrhoea?
- rule out breast cancer
- treat underlying cause
- dopamine agonists -block prolactin secretion and improve symptoms
- surgical removal of pituitary tumour
Define Phaeochromocytoma?
refers to a tumour in the adrenal glands that secretes unregulated or excessive amounts of catecholamines (adrenaline).
Causes of phaeochromocytoma?
Catecholamine-producing tumour
- abnormal secretion of epinephrine and norepinephrine
Presentation of phaeochromocytoma?
- Signs and symptoms fluctuate depending on when the tumour is secreting adrenaline.
- Anxiety
- Sweating
- Headache
- Tremor
- Palpitations
- Hypertension
- Hypertensive retinopathy
- Postural hypotension
- Tachycardia
- wt loss
- dyspnea
- Abdominal pain
IVx/diagnosis of phaeochromocytoma?
- 24-hour urine catecholamines →tells how much adrenalineis being secreted by the tumour over 24 hours.
- urine glucose during episodes
- CT/MRI of the adrenal gland →check for tumours
Management of phaeochromocytoma?
Alpha blockers (e.g. phenoxybenzamineordoxazosin)
BB (do not use atenolol -risk of unopposed alpha agonism and severe refractory HTN)
Surgical removalof the tumour
Blood pressure control
