Gynaecomatia Flashcards
What is gynaecomastia?
Males develop breast tissue due to an imbalanced ratio of oestrogen and androgen activity. Usually benign but 1% can develop breast cancer.
Usually entirely reversible and quite common.
What are the two types of gynaecomastia?
Physiological gynaecomastia
Pathological gynaecomastia
What is physiological gynaecomastia?
Most commonly in adolescence due to delayed testosterone surge relative to oestrogen. Less common in older population due to decreased testosterone levels with increasing age.
What are the different underlying mechanisms for pathological gynaecomastia
Lack of testosterone - klinefelters syndrome, androgen insensitivity, testicular atrophy or renal disease
Increased oestrogen levels - liver disease, hyperthyroidism, obesity, adrenal tumours or certain testicular tumours
Medication- digoxin, metronidazole, spironolactone, chemo, anti-psychotics, anabolic steroids
Idiopathic
What are the clinical features of gynaecomastia?
Gradual onset. Associated symptoms of co-morbities must be asked about and feature of potential underlying cause.
Testicular examination essential in younger patients
On breast examination - rubbery or firm mass that starts from underneath the nipple and spreads outwards over the breast region.
What are the differential diagnosis for gynaecomastia?
Pseudogynaecomatia
Obesity
What are the investigations for gynaecomastia?
Only require if cause unknown or malignancy suspected.
Malignancy - triple assessment
Others - LFTS and U&Es before hormone profiles
What are the clinical pictures indicated on hormone levels in gynaecomastia?
LH high and testosterone low = testicular failure
LH low and testosterone low = increased osetrogen
LH high and testosterone high = androgen resistant or gonadotropin-secreting malignancy
What are the management option for gynaecomastia?
Treat underlying cause
Reassurance
Tamoxifen used in some cases to help alleviate symptoms especially tenderness
Later stage of fibrosis - surgery may be required
