Gynecomastia

Document onset, progression, laterality, tenderness, nipple discharge, sexual function, change in virilization, weight change, hyperthyroid symptoms, and recent recovery from malnutrition or serious illness. Review prescription and nonprescription agents, supplements and herbal products, cosmetic exposures, cannabis and other recreational substances, and anabolic-androgenic steroid use. Also ask about renal disease, liver disease, thyroid disease, infertility, and family or syndromic features suggesting Klinefelter syndrome. Wolters Kluwer+3Wolters KluwerGynecomastia in adolescents : Current Opinion in PediatricsScienceDirect1 Testosterone - an overview | ScienceDirect Topicsccjm[PDF] Gynecomastia - Cleveland Clinic Journal of MedicinePubMed[Disordered hormone regulation in gynecomastia] - PubMed

Examine whether enlargement is palpable subareolar glandular tissue versus predominantly adiposity, then assess regional lymph nodes, skin and nipple findings, thyroid, abdomen for hepatomegaly or mass, body hair and other virilization, and both testes for volume asymmetry, atrophy, or a discrete mass. A breast mass suspicious for malignancy requires mammography and biopsy rather than empiric hormonal therapy. ScienceDirect+1ScienceDirect1 Testosterone - an overview | ScienceDirect Topicsccjm[PDF] Gynecomastia - Cleveland Clinic Journal of Medicine

Recent, prominent, painful, progressive, or otherwise unexplained enlargement warrants directed evaluation because it can signal drug exposure, gonadal failure, altered estrogen production, renal or hepatic disease, thyrotoxicosis, or a tumor. Conversely, an adolescent with otherwise typical pubertal development, a reassuring breast and testicular examination, and no concerning history generally does not need routine hormonal testing. Wolters Kluwer+2Wolters KluwerGynecomastia in adolescents : Current Opinion in PediatricsPubMed[Disordered hormone regulation in gynecomastia] - PubMedplasticsurgeryMost Teens with Gynecomastia Don't Need Hormone Lab Tests | ASPS

For recent-onset or unexplained gynecomastia, measure serum total and free or bioavailable testosterone, LH, FSH, estradiol, beta-hCG, prolactin, thyroid-stimulating hormone with free thyroxine, serum creatinine, and liver enzymes. Add DHEA-S or urinary 17-ketosteroids when a feminizing adrenal tumor is in the differential. These tests distinguish androgen deficiency, altered gonadotropin signaling, hCG- or estradiol-associated tumor physiology, hyperprolactinemia, thyrotoxicosis, and renal or hepatic contributors. ccjm+1ccjm[PDF] Gynecomastia - Cleveland Clinic Journal of MedicinePubMed[Disordered hormone regulation in gynecomastia] - PubMed

Interpret hormone results as a pattern rather than in isolation. Low testosterone with altered LH and FSH supports evaluation for hypogonadism; elevated beta-hCG or estradiol, or depressed LH in an otherwise unexplained presentation, should prompt testicular ultrasonography. If testicular ultrasonography is normal despite these abnormalities, proceed to chest radiography and abdominal CT to search for an extratesticular or adrenal source. Wolters Kluwer+1Wolters KluwerMultidisciplinary Team Care: Adolescent BreastScienceDirect1 Testosterone - an overview | ScienceDirect Topics

Reserve pituitary MRI for a laboratory or clinical pattern that localizes to the sella, rather than using it as routine imaging. Similarly, adrenal CT should follow clinical or biochemical concern for an adrenal mass. Routine imaging without examination or laboratory triggers is not recommended. ccjmccjm[PDF] Gynecomastia - Cleveland Clinic Journal of Medicine

When a medication, supplement, estrogen-containing exposure, recreational substance, or anabolic-androgenic steroid is implicated, discontinue, replace, or stop the exposure when clinically feasible and reassess the breast examination and symptoms. Drug-induced gynecomastia may regress after withdrawal, but prolonged disease is less likely to resolve completely after fibrotic change develops. Wolters Kluwer+3Wolters KluwerGynecomastia in adolescents : Current Opinion in PediatricsOxford AcademicAndrogen Misuse and Abuse | Endocrine Reviews - Oxford AcademicPubMedGynecomastia: Clinical evaluation and managementccjm[PDF] Gynecomastia - Cleveland Clinic Journal of Medicine

Treat identified systemic and endocrine causes rather than treating breast enlargement in isolation. Relevant branches include hypogonadism, thyrotoxicosis, renal or hepatic dysfunction, hyperprolactinemia, and testicular, adrenal, or other malignancy-associated hormone production. The diagnostic pattern should determine the referral and definitive therapy rather than a uniform antiestrogen strategy. ScienceDirect+2ScienceDirect1 Testosterone - an overview | ScienceDirect Topicsccjm[PDF] Gynecomastia - Cleveland Clinic Journal of MedicinePubMed[Disordered hormone regulation in gynecomastia] - PubMed

For asymptomatic, long-standing adult gynecomastia without concerning findings, reassurance is appropriate. For new-onset disease, follow-up is reasonable because spontaneous regression occurs in adolescents and adults, whereas persistence beyond 1 year is associated with a low likelihood of complete regression. PubMedPubMedGynecomastia: Clinical evaluation and management

Do not combine anastrozole with tamoxifen: coadministration lowers anastrozole concentration and provided no efficacy benefit over tamoxifen in breast cancer trial data. Anastrozole has not demonstrated efficacy for pubertal gynecomastia and is not an established treatment for that indication. dailymed nlm nih+3dailymed nlm nihHIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use anastrozole tablets safely and effectively. See full prescribing information for anastrozole tablets. Initial U.S. Approvaldailymed nlm nihhighlights of prescribing information - DailyMedaccessdata fda[PDF] Arimidex (anastrozole) tablet label - accessdata.fda.govaccessdata fda[PDF] 20541Orig1s023 - accessdata.fda.gov

Consider surgical treatment for long-standing gynecomastia, generally beyond 12 months, when there is considerable pain, psychological stress, cosmetic concern, or concern for malignancy. Subcutaneous mastectomy is the most commonly used operative technique for glandular tissue; technique selection depends on the relative fat, parenchyma, skin laxity, and severity of enlargement. PubMedPubMedGynecomastia: Clinical evaluation and management

In adolescents, defer elective surgery until the testes have reached adult size because breast tissue can regrow if surgery occurs before pubertal completion. Surgery may nevertheless be necessary for a suspicious lesion, in which case diagnostic priorities supersede cosmetic timing. PubMedPubMedGynecomastia: Clinical evaluation and management

Liposuction may be used with mammoplasty in men with gynecomastia when body contour and adipose contribution warrant it. In body-contouring data, reported overall liposuction complication rates were 2.4%, including 0.7% for liposuction alone and 3.5% when combined with other procedures; complications include ecchymosis, edema, infection, seroma, hematoma, and venous thromboembolism. These estimates are not specific to gynecomastia operations. ccjmccjmLiposuction: Concepts, safety, and techniques in body-contouring surgery | Cleveland Clinic Journal of medicine