Gynecomastia

#med #disease #y2023 #endo

Presentation :

Diagnosis is confirmed by finding subareolar glandular tissue >0.5 cm in diameter and is usually bilateral
- Must differentiate gynecomastia from pseudogynecomastia, which is fat deposition typically seen in men with obesity

caused by proliferation of glandular tissues in the male breast because of an increase in the ratio of estrogen to androgen
Etiologies include:
- medications (spironolactone, cimetidine, antiandrogens, 5α-reductase inhibitors, protease inhibitors)
- opioid use
- cirrhosis, CKD
- hypogonadism, hyperthyroidism
- germ cell tumors

In patients without an obvious cause, obtain hCG and 8 AM fasting testosterone and estradiol levels.
Obtain mammography for unilateral, nontender, or fixed masses to diagnose breast cancer.

Treatment of a specific cause of gynecomastia during the active proliferative phase may result in regression in size of the abnormal tissue
Selective estrogen receptor modulators, aromatase inhibitors, and androgens/testosterone (for men with hypogonadism) are commonly used medications
If gynecomastia is longstanding, regression (spontaneously or with medical therapy) is unlikely because of fibrotic changes. In this scenario, referral for plastic surgery may be the best option for cosmetic improvement.