Materiały źródłowe

• #1 Gynecomastia: What It Is, Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/symptoms/16227-enlarged-male-breast-tissue-gynecomastia

  Gynecomastia is enlarged breast (chest) tissue in males. Its a benign (noncancerous) increase in breast volume due to an increase in glandular tissue. […] Gynecomastia most often happens due to an imbalance of hormones specifically testosterone and estrogen. […] Gynecomastia is the enlargement of glandular tissue in your breast(s). Estrogen is responsible for the growth of glandular breast tissue. Estrogen also suppresses the release of testosterone. […] Gynecomastia may be a symptom or result of the following health conditions: Adrenal tumors, Hyperthyroidism (overactive thyroid), Kidney disease or kidney failure, Klinefelter syndrome (an inherited condition), Liver disease and cirrhosis, Male hypogonadism (low testosterone), Pituitary gland tumors (pituitary adenomas), especially prolactinomas, Testicular tumors. […] If gynecomastia is causing you distress and/or you have other new symptoms, talk to your healthcare provider. They can check to see if an underlying medical condition is the cause and discuss potential treatment options.

• #2 Gynecomastia – Wikipedia

  https://en.wikipedia.org/wiki/Gynecomastia

  Gynecomastia is the most common benign disorder of the male breast tissue and affects 35% of men, being most prevalent between the ages of 50 and 69. […] Most occurrences of gynecomastia do not require diagnostic tests. […] To diagnose gynecomastia, a thorough history and physical examination are obtained by a physician. Important aspects of the physical examination include evaluation of the male breast tissue with palpation to evaluate for breast cancer and pseudogynecomastia (male breast tissue enlargement solely due to excess fatty tissue), evaluation of penile size and development, evaluation of testicular development and an assessment for masses that raise suspicion for testicular cancer, and proper development of secondary sex characteristics such as the amount and distribution of pubic and underarm hair.

• #3 Gynaecomastia–pathophysiology, diagnosis and treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/25112235/

  Gynaecomastia (enlargement of the male breast tissue) is a common finding in the general population. […] Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance. […] However, the condition might cause local pain and tenderness, could occasionally be the result of a serious underlying illness or a medication, or be inherited. […] Breast cancer in men is much less common than benign gynaecomastia, and the two conditions can usually be distinguished by a careful physical examination. […] In some cases, such as pubertal gynaecomastia, the breast enlargement resolves spontaneously. […] In other situations, more active treatment might be required to correct an underlying condition (such as hyperthyroidism or a benign Leydig cell tumour of the testis) or medications that could cause breast enlargement (such as spironolactone) might need to be discontinued. […] For men with hypogonadism, administration of androgens might be helpful, as might antiestrogen therapy in men with endogenous overproduction of estrogens. […] Surgery to remove the enlarged breast tissue might be necessary when gynaecomastia does not resolve spontaneously or with medical therapy.

• #4 Gynaecomastia – Differential Diagnosis – Investigations – TeachMeSurgery

  https://teachmesurgery.com/breast/benign-disease/gynaecomastia/

  Gynaecomastia is a condition by which males develop breast tissue due to an imbalanced ratio of oestrogen and androgen activity. It is usually a benign disease but breast cancer can develop in about 1% of cases. […] Gynaecomastia often has an insidious onset. Ensure to ask about associated symptoms and co-morbidities during assessment, and to assess for clinical features of potential underlying causes, including malignancy, during examination. […] Tests are only necessary if the cause for gynaecomastia is unknown (especially if physiological or iatrogenic). In cases where malignancy is suspected, patients will require the triple assessment. […] The management ultimately depends on the causative factors and the phase of gynaecomastia. If there is a reversible underlying cause, then treatment or reversal of this should also allow for the resolution of the gynaecomastia as well. […] Tests are only necessary if the cause for gynaecomastia is uncertain; any suspicion of malignancy requires the triple assessment.

• #5 Gynaecomastia—pathophysiology, diagnosis and treatment | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2014.139

  Gynaecomastia is a common condition and is usually benign. […] Gynaecomastia typically results from an (absolute or relative) deficiency of androgen action or excessive estrogen action in the breast tissue. […] Gynaecomastia often resolves by itself or upon removal of the underlying cause (such as medication). […] Treatment is indicated in men with symptoms (particularly pain and tenderness in the breast) and involves the use of androgens or antiestrogens. […] Surgery can be offered to selected patients when the condition does not resolve spontaneously or respond to medical treatment. […] Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance. […] However, the condition might cause local pain and tenderness, could occasionally be the result of a serious underlying illness or a medication, or be inherited.

• #6 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  At presentation, all patients require a thorough history and physical exam. Particular attention should be given to medications, drugs and alcohol abuse, as well as other chemical exposures. Symptoms of underlying systemic illness, such as hyperthyroidism, liver disease, or renal failure should be sought. […] All patients who present with gynecomastia should have serum testosterone, estradiol, LH, and hCG measured. Further testing should be tailored according to the history, physical examination and the results of these initial tests. An elevated beta hCG or hCG or a markedly elevated serum estradiol suggests neoplasm and a testicular ultrasound is warranted to identify a testicular tumor. […] Treatment of the underlying endocrinologic or systemic disease that has caused gynecomastia is appropriate when possible. Testicular tumors, such as Leydig cell, Sertoli cell, or granulosa cell tumors should be surgically removed.

• #7 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  Gynecomastia is defined as benign proliferation of glandular breast tissue in men. […] Routine testicular ultrasonography should be considered in men with gynecomastia to detect nonpalpable testicular tumors that were missed on clinical examination. […] Mammography and breast ultrasonography should be performed in men if the physical examination raises suspicion for breast cancer. […] The history should rule out other causes of breast enlargement, such as those listed in Table 3. […] Symptoms that last longer than one to two years suggest nonphysiologic causes that require intervention for resolution. […] The physical examination should include evaluation of height and weight, and examination of the breasts, genitals, liver, lymph nodes, and thyroid. […] Assessment of symmetry and consistency of breast tissue is critical on breast examination.

• #8 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-Gynecomastia.aspx

  Once symptoms of Gynecomastia are seen, patient needs to be evaluated in detail to exclude breast cancer. […] Diagnosis begins with taking a medical history and doing a detailed physical examination. […] Questions to evaluate the adequate growth and development of other secondary sexual characters in the adult patient with Gynecomastia is also important. Symptoms of decreased libido or erectile dysfunction may point towards low testosterone. […] Progression of the swelling whether it is increasing, decreasing or remaining the same – needs to be known. […] Rapid growth of the breast tissues may point towards an underlying cancer. […] Physical examination is important in diagnosing other causes of Gynecomastia. […] On examination of the breast it is checked if the swelling is fatty tissue (not truly Gynecomastia) or breast tissue.

• #9 Gynecomastia in adolescent males: current understanding of its etiology, pathophysiology, diagnosis, and treatment

  https://e-apem.org/journal/view.php?number=1034

  Gynecomastia (GM) is a common and continuously evolving condition that commonly occurs during adolescence. […] The aim of this review is to highlight the significance of GM during adolescence in terms of potential etiologies, clinical and laboratory diagnoses, and current management. […] The challenge facing endocrinologists lies in their ability to distinguish between physiological and pathologic causes of GM. […] For all adolescents presenting with GM, a detailed history and physical examination should be performed to differentiate pathologic from pubertal GM. […] A detailed medical history should include the onset and duration of breast enlargement, pain or tenderness, presence of nipple discharge or overlying skin changes, undervirilization, and testicular swelling or masses. […] The choice of laboratory or radiological tests for evaluation of GM is influenced by the clinical picture.

• #10 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  Gynecomastia is defined as benign proliferation of glandular breast tissue in men. […] Routine testicular ultrasonography should be considered in men with gynecomastia to detect nonpalpable testicular tumors that were missed on clinical examination. […] Mammography and breast ultrasonography should be performed in men if the physical examination raises suspicion for breast cancer. […] The history should rule out other causes of breast enlargement, such as those listed in Table 3. […] Symptoms that last longer than one to two years suggest nonphysiologic causes that require intervention for resolution. […] The physical examination should include evaluation of height and weight, and examination of the breasts, genitals, liver, lymph nodes, and thyroid. […] Assessment of symmetry and consistency of breast tissue is critical on breast examination.

• #11 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  At presentation, all patients require a thorough history and physical exam. Particular attention should be given to medications, drugs and alcohol abuse, as well as other chemical exposures. Symptoms of underlying systemic illness, such as hyperthyroidism, liver disease, or renal failure should be sought. […] All patients who present with gynecomastia should have serum testosterone, estradiol, LH, and hCG measured. Further testing should be tailored according to the history, physical examination and the results of these initial tests. An elevated beta hCG or hCG or a markedly elevated serum estradiol suggests neoplasm and a testicular ultrasound is warranted to identify a testicular tumor. […] Treatment of the underlying endocrinologic or systemic disease that has caused gynecomastia is appropriate when possible. Testicular tumors, such as Leydig cell, Sertoli cell, or granulosa cell tumors should be surgically removed.

• #12 Clinical features, diagnosis, and evaluation of gynecomastia in adults – UpToDate

  https://www.uptodate.com/contents/clinical-features-diagnosis-and-evaluation-of-gynecomastia-in-adults/print

  Clinical features, diagnosis, and evaluation of gynecomastia in adults […] Gynecomastia, a benign proliferation of the glandular tissue of the male breast, is diagnosed on examination. […] A study of 506 adolescent and adult males presenting to emergency departments with trauma who underwent a chest computed tomography (CT) scan showed that some breast glandular tissues in males is a normal finding with 90th, 95th, and 97.5th percentiles of normal breast tissue being 2.2, 2.6, and 3.6 cm, respectively. Therefore, breast glandular tissue that is <2 cm should be considered a normal finding, but palpable enlargement ≥2 cm is gynecomastia.

• #13 Clinical features, diagnosis, and evaluation of gynecomastia in adults – UpToDate

  https://www.uptodate.com/contents/clinical-features-diagnosis-and-evaluation-of-gynecomastia-in-adults

  Clinical features, diagnosis, and evaluation of gynecomastia in adults […] Gynecomastia, a benign proliferation of the glandular tissue of the male breast, is diagnosed on examination. […] The clinical features and evaluation of gynecomastia will be reviewed here. […] Physical findings — In true gynecomastia, a ridge of glandular tissue will be felt that is reasonably symmetrical to the nipple-areolar complex. […] Breast glandular tissue can usually be detected when the size exceeds 0.5 cm in diameter. […] Therefore, breast glandular tissue that is <2 cm should be considered a normal finding, but palpable enlargement ≥2 cm is gynecomastia.

• #14 The Radiology Assistant : Pathology of the Male Breast

  https://radiologyassistant.nl/breast/male-breast/pathology-of-the-male-breast

  Gynecomastia is the most common abnormality in the male breast. Clinically, it presents as a soft mobile tender subareolar mass. Every word in this sentence is critical: soft – mobile – tender – subareolar. So it has to be soft and mobile. It is tender in the acute phase, but not in the chronic phase. Gynecomastia must be subareolar! Any mass that is not subareolar is not gynecomastia. […] By definition gynecomastia is 2 cm or more of subareolar tissue in a non obese male. It is a common 'normal’ finding, that is seen in 55% of men at autopsy. The peak incidence is 60 – 69 years. It is significant if it is new or symptomatic. In elderly males gynecomastia makes up 65% of all breast lesions. 25% is carcinoma and 10% are other lesions. […] In conclusion we can say, that male breast disease either presents as mass, pain or nipple discharge. Gynecomastia and invasive ductal cancer are the most common lesions in the male breast, but there are other rarer benign and malignant lesions. Gynecomastia and carcinoma can usually be differentiated, but biopsy is sometimes necessary to separate them. All lesions eccentric to the nipple need biopsy unless they are characteristically benign, i.e.contain fat or typical lymph node.

• #15 How to Perform the Gynecomastia Pinch Test | Sieber Plastic Surgery

  https://www.sieberplasticsurgery.com/articles/how-to-perform-the-gynecomastia-pinch-test/

  Sometimes called man boobs, gynecomastia is a medical condition in which males have excess breast tissue beneath and around their nipples. […] In this article, we’ll be discussing the gynecomastia pinch test, which is a simple test that you (or your doctor) can perform to help determine if you have gynecomastia. […] To know if you have glandular gynecomastia or fatty gynecomastia, we recommend performing the gynecomastia pinch test, which we will outline below. […] The gynecomastia pinch test is the term sometimes used for an at-home test that can help patients deduce whether they have gynecomastia. It involves lightly palpating the area surrounding and beneath the nipple. […] Remember that only a certified medical professional can officially diagnose gynecomastia, but this test can give you a place to start.

• #16 Gynecomastia Pinch Test a Self Diagnosis | Miguel Delgado M.D.

  https://www.gynecomastia-specialist.com/gynecomastia-physical-exam/

  In order to reduce enlarged male breasts, it is important to get the correct diagnosis. […] A gynecomastia pinch test will not always identify the specific cause of man boobs but can determine whether it is fat or breast glands. […] It is recommended that you consult a gynecomastia specialist, such as Dr. Delgado if you are experiencing male breast enlargement. A comprehensive physical examination and a review of your medical history will be required for the diagnosis of gynecomastia. […] To determine whether the condition is true gynecomastia or pseudogynecomastia, a physical examination and gynecomastia pinch test is conducted. […] The gynecomastia pinch test can determine pseudogynecomastia or excess fat build up. […] A gynecomastia pinch test is performed by pinching the deep tissue under the nipple in the male breasts. Gynecomastia breast tissue feels like firm tissue but the excess fat is soft and spongy. […] The gynecomastia pinch test is a gynecomastia physical exam to diagnose gynecomastia from excess fat or pseudogynecomastia.

• #17 Enlarged breasts in men (gynecomastia) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gynecomastia/diagnosis-treatment/drc-20351799

  To find out if you have gynecomastia, a member of your health care team starts by asking you some questions. For example, you’ll likely be asked about your symptoms and any medicines you take. You’re also given a medical exam to check your breast tissue, stomach area and genitals. […] Your health care team likely will order tests. These can help find a possible cause of gynecomastia or look for conditions that can cause similar symptoms. Tests also may be done to check for breast cancer. […] Your health care team will want to be sure that your breast swelling is gynecomastia and not another condition. Other conditions that can cause similar symptoms include: […] Breast cancer is uncommon in men, but it can happen. Enlargement of one breast or the presence of a firm lump raises the concern for male breast cancer. […] Clinical features, diagnosis, and evaluation of gynecomastia in adults.

• #18 Gynecomastia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/gynecomastia-1?lang=us

  Focal gynecomastia can variably appear as a retroareolar, triangular, hypoechoic mass. […] In chronic dendritic gynecomastia, there is often a subareolar hypoechoic lesion with an anechoic star-shaped posterior border, which can be described as fingerlike projections or „spider legs” insinuating into the surrounding echogenic fibrous breast tissue. […] Pseudogynecomastia: involves breast enlargement (usually bilateral) caused by an excess of adipose tissue, which is not necessarily associated with constitutional obesity. […] Male breast cancer: unilateral fixed painless irregular hard mass may occur remotely from the areola (gynecomastia does not).

• #19 Gynecomastia Workup: Approach Considerations

  https://emedicine.medscape.com/article/120858-workup

  Patients with physiologic gynecomastia do not require further evaluation. […] Similarly, asymptomatic and pubertal gynecomastia do not require further tests and should be reevaluated in 6 months. […] Further evaluation is necessary in patients with the following: Breast size greater than 5 cm (macromastia). […] A lump that is tender, of recent onset, progressive, or of unknown duration. […] Signs of malignancy (eg, hard or fixed lymph nodes or positive lymph node findings). […] A serum chemistry panel may be helpful in evaluating for renal or liver disease. […] Free or total testosterone, luteinizing hormone (LH), estradiol, and dehydroepiandrosterone sulfate levels are used to evaluate a patient with possible feminization syndrome. […] Obtain thyroid-stimulating hormone (TSH) and free thyroxine levels if hyperthyroidism is suspected.

• #20 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Gynecomastia is a benign enlargement of the male breast (usually bilateral but sometimes unilateral) resulting from a proliferation of the glandular component of the breast. It is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. Gynecomastia should be differentiated from pseudogynecomastia (lipomastia), which is characterized by fat deposition without glandular proliferation. […] Patients with physiologic gynecomastia do not require further evaluation. Similarly, asymptomatic and pubertal gynecomastia do not require further tests and should be reevaluated in 6 months. Further evaluation is necessary in the following situations: Breast size greater than 5 cm (macromastia), A lump that is tender, of recent onset, progressive, or of unknown duration, Signs of malignancy (eg, hard or fixed lymph nodes or positive lymph node findings).

• #21 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  The history and physical examination should direct the laboratory and imaging workup. […] Laboratory studies to investigate the underlying cause of gynecomastia should include measurement of hepatic transaminase, serum creatinine, and thyroid-stimulating hormone levels for all patients. […] Recommendations for imaging studies are based mainly on case reports and expert opinion. […] Fine-needle aspiration of masses for cytology should be pursued only if malignancy is suspected.

• #22 Gynecomastia – Wikipedia

  https://en.wikipedia.org/wiki/Gynecomastia

  Diagnosis of men with breast enlargement can be evaluated using an algorithm. […] Recommended laboratory investigations to find the underlying cause of gynecomastia include tests for aspartate transaminase and alanine transaminase to rule out liver disease, serum creatinine to determine if kidney damage is present, and thyroid-stimulating hormone levels to evaluate for hyperthyroidism. […] If these initial laboratory tests fail to uncover the cause of gynecomastia, then additional tests to evaluate for an underlying hormonal balance due to hypogonadism or a testicular tumor should be checked including total and free levels of testosterone, luteinizing hormone, follicle stimulating hormone, estradiol, serum beta human chorionic gonadotropin (-hCG), and prolactin. […] High levels of prolactin are uncommon in people with gynecomastia. […] If -hCG levels are abnormally high, then ultrasound of the testicles should be performed to check for signs of a hormone-secreting testicular tumor. […] If this evaluation does not reveal the cause of gynecomastia, then it is considered to be idiopathic gynecomastia (of unclear cause).

• #23 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  At presentation, all patients require a thorough history and physical exam. Particular attention should be given to medications, drugs and alcohol abuse, as well as other chemical exposures. Symptoms of underlying systemic illness, such as hyperthyroidism, liver disease, or renal failure should be sought. […] All patients who present with gynecomastia should have serum testosterone, estradiol, LH, and hCG measured. Further testing should be tailored according to the history, physical examination and the results of these initial tests. An elevated beta hCG or hCG or a markedly elevated serum estradiol suggests neoplasm and a testicular ultrasound is warranted to identify a testicular tumor. […] Treatment of the underlying endocrinologic or systemic disease that has caused gynecomastia is appropriate when possible. Testicular tumors, such as Leydig cell, Sertoli cell, or granulosa cell tumors should be surgically removed.

• #24 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Laboratory tests that may be considered include the following: Serum chemistry panel, Free or total testosterone, luteinizing hormone (LH), estradiol, and dehydroepiandrosterone sulfate levels, Thyroid-stimulating hormone (TSH) and free thyroxine levels. […] Imaging studies that may be helpful include the following: Mammography: Indicated if one or more features of breast cancer are apparent upon clinical examination, followed by fine-needle aspiration or breast biopsy as appropriate, Testicular ultrasonography: Indicated if the serum estradiol level is elevated and the clinical examination findings suggest the possibility of a testicular neoplasm, Breast ultrasonography (though the positive predictive value of imaging in males is low), Computed tomography (CT) scanning: Gynecomastia is often reported on CT scans.

• #25 Gynecomastia Workup: Approach Considerations

  https://emedicine.medscape.com/article/120858-workup

  Patients with physiologic gynecomastia do not require further evaluation. […] Similarly, asymptomatic and pubertal gynecomastia do not require further tests and should be reevaluated in 6 months. […] Further evaluation is necessary in patients with the following: Breast size greater than 5 cm (macromastia). […] A lump that is tender, of recent onset, progressive, or of unknown duration. […] Signs of malignancy (eg, hard or fixed lymph nodes or positive lymph node findings). […] A serum chemistry panel may be helpful in evaluating for renal or liver disease. […] Free or total testosterone, luteinizing hormone (LH), estradiol, and dehydroepiandrosterone sulfate levels are used to evaluate a patient with possible feminization syndrome. […] Obtain thyroid-stimulating hormone (TSH) and free thyroxine levels if hyperthyroidism is suspected.

• #26 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  At presentation, all patients require a thorough history and physical exam. Particular attention should be given to medications, drugs and alcohol abuse, as well as other chemical exposures. Symptoms of underlying systemic illness, such as hyperthyroidism, liver disease, or renal failure should be sought. […] All patients who present with gynecomastia should have serum testosterone, estradiol, LH, and hCG measured. Further testing should be tailored according to the history, physical examination and the results of these initial tests. An elevated beta hCG or hCG or a markedly elevated serum estradiol suggests neoplasm and a testicular ultrasound is warranted to identify a testicular tumor. […] Treatment of the underlying endocrinologic or systemic disease that has caused gynecomastia is appropriate when possible. Testicular tumors, such as Leydig cell, Sertoli cell, or granulosa cell tumors should be surgically removed.

• #27 Important Lab Tests to Detect Gynecomastia in Males – MyHealth

  https://redcliffelabs.com/myhealth/health/important-lab-tests-to-detect-gynecomastia-in-males/

  Breast enlargement in men, known as Gynecomastia, is more common than you might think. […] Consult your doctor and take the blood test for male Gynecomastia to identify what’s causing the change. […] The blood test for male Gynecomastia identifies the underlying factors and chooses the appropriate treatment. […] The hormone test for Gynecomastia helps understand testosterone levels in males. […] The test helps to measure testosterone levels in the blood. […] The test assesses the number and sensitivity of estrogen receptors in breast tissue. […] The DHEA test identifies hormonal imbalances causing Gynecomastia. […] High LH levels may indicate testicular dysfunction that may cause low testosterone and, consequently, Gynecomastia. […] The thyroid profile test detects the TSH levels and helps to identify abnormalities in thyroid function that can affect breast tissue and cause Gynecomastia.

• #28 Gynecomastia Workup: Approach Considerations

  https://emedicine.medscape.com/article/120858-workup

  Order a mammogram if 1 or more features of breast cancer are apparent upon clinical examination. […] This can be followed by fine-needle aspiration or breast biopsy, as the case merits. […] Obtain a testicular ultrasonogram if the serum estradiol level is elevated and the clinical examination findings suggest the possibility of a testicular neoplasm. […] Breast imaging, through mammography or ultrasonography, may be controversial, because gynecomastia is much more common than male breast cancer. […] The positive predictive value of imaging in males is 55% using mammography and 17% using ultrasonography. […] However, a study by Telegrafo et al in which ultrasonography was used to diagnosis and classify gynecomastia found the same results as when mammography was used, suggesting that ultrasonography can be employed as a primary imaging modality for determining the presence of gynecomastia and categorizing its shape.

• #29 Gynecomastia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/gynecomastia/

  Breast imaging is not routinely recommended in patients with clinical features consistent with gynecomastia or pseudogynecomastia. […] Some guidelines recommend testicular ultrasound for all individuals with gynecomastia; others recommend imaging only in the following cases: suspected testicular tumor, suspected hypogonadism, gynecomastia 5 cm, pathological gynecomastia of unknown etiology. […] If all laboratory tests are normal, including the hormone profile, gynecomastia is likely idiopathic.

• #30 Gynecomastia Workup: Approach Considerations

  https://emedicine.medscape.com/article/120858-workup

  Order a mammogram if 1 or more features of breast cancer are apparent upon clinical examination. […] This can be followed by fine-needle aspiration or breast biopsy, as the case merits. […] Obtain a testicular ultrasonogram if the serum estradiol level is elevated and the clinical examination findings suggest the possibility of a testicular neoplasm. […] Breast imaging, through mammography or ultrasonography, may be controversial, because gynecomastia is much more common than male breast cancer. […] The positive predictive value of imaging in males is 55% using mammography and 17% using ultrasonography. […] However, a study by Telegrafo et al in which ultrasonography was used to diagnosis and classify gynecomastia found the same results as when mammography was used, suggesting that ultrasonography can be employed as a primary imaging modality for determining the presence of gynecomastia and categorizing its shape.

• #31 Gynecomastia: Symptoms, Diagnosis and Treatment | Baylor Scott & White Health

  https://www.bswhealth.com/conditions/gynecomastia

  Gynecomastia is a condition that occurs when the small amount of normal breast tissue found in males increases or grows more than it should. […] If you have symptoms of gynecomastia, our team offers complete care to help diagnose your situation and provide treatment options. […] To help diagnose, your doctor will conduct a physical exam and ask you questions about your health history. […] In some cases, you may have blood tests, or you may not need any additional testing for the condition. […] If a hormone imbalance appears to be the cause, your doctor might refer you to an endocrinologist, a physician who specializes in the endocrine system and hormone health. […] Because both gynecomastia and breast cancer can cause breast lumps, your provider may order one of the following tests to get more details if you have a lump: Diagnostic mammogram, Breast ultrasound, Breast biopsy.

• #32 Gynecomastia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/gynecomastia-1?lang=us

  Focal gynecomastia can variably appear as a retroareolar, triangular, hypoechoic mass. […] In chronic dendritic gynecomastia, there is often a subareolar hypoechoic lesion with an anechoic star-shaped posterior border, which can be described as fingerlike projections or „spider legs” insinuating into the surrounding echogenic fibrous breast tissue. […] Pseudogynecomastia: involves breast enlargement (usually bilateral) caused by an excess of adipose tissue, which is not necessarily associated with constitutional obesity. […] Male breast cancer: unilateral fixed painless irregular hard mass may occur remotely from the areola (gynecomastia does not).

• #33 Gynecomastia Workup: Approach Considerations

  https://emedicine.medscape.com/article/120858-workup

  Order a mammogram if 1 or more features of breast cancer are apparent upon clinical examination. […] This can be followed by fine-needle aspiration or breast biopsy, as the case merits. […] Obtain a testicular ultrasonogram if the serum estradiol level is elevated and the clinical examination findings suggest the possibility of a testicular neoplasm. […] Breast imaging, through mammography or ultrasonography, may be controversial, because gynecomastia is much more common than male breast cancer. […] The positive predictive value of imaging in males is 55% using mammography and 17% using ultrasonography. […] However, a study by Telegrafo et al in which ultrasonography was used to diagnosis and classify gynecomastia found the same results as when mammography was used, suggesting that ultrasonography can be employed as a primary imaging modality for determining the presence of gynecomastia and categorizing its shape.

• #34 Gynecomastia Workup: Approach Considerations

  https://emedicine.medscape.com/article/120858-workup

  Order a mammogram if 1 or more features of breast cancer are apparent upon clinical examination. […] This can be followed by fine-needle aspiration or breast biopsy, as the case merits. […] Obtain a testicular ultrasonogram if the serum estradiol level is elevated and the clinical examination findings suggest the possibility of a testicular neoplasm. […] Breast imaging, through mammography or ultrasonography, may be controversial, because gynecomastia is much more common than male breast cancer. […] The positive predictive value of imaging in males is 55% using mammography and 17% using ultrasonography. […] However, a study by Telegrafo et al in which ultrasonography was used to diagnosis and classify gynecomastia found the same results as when mammography was used, suggesting that ultrasonography can be employed as a primary imaging modality for determining the presence of gynecomastia and categorizing its shape.

• #35 Prevalence of Incidental Gynecomastia by Chest Computed Tomography in Patients with a Prediagnosis of COVID-19 Pneumonia – European Journal of Breast Health

  https://www.eurjbreasthealth.com/articles/prevalence-of-incidental-gynecomastia-by-chest-computed-tomography-in-patients-with-a-prediagnosis-of-covid-19-pneumonia/doi/ejbh.galenos.2021.6251

  In this study, we aimed to determine the prevalence of gynecomastia by evaluating computed tomography (CT) images of male patients who were admitted to our hospital during the coronavirus disease-2019 (COVID-19) pandemic. […] The prevalence of gynecomastia was 32.3%. […] In our study, gynecomastia diagnosis was made through axial CT images. Although CT should not replace mammography and ultrasonography for clinical diagnosis of gynecomastia, chest CT scans can be used to evaluate patients with suspected gynecomastia. […] The diagnosis of gynecomastia is important for patients to know that they do not have a malignant lesion and, if the cause of gynecomastia is found, to plan treatment. […] If gynecomastia is detected with computed tomography (CT), the patient should be evaluated clinically.

• #36 Gynecomastia Workup: Approach Considerations

  https://emedicine.medscape.com/article/120858-workup

  Order a mammogram if 1 or more features of breast cancer are apparent upon clinical examination. […] This can be followed by fine-needle aspiration or breast biopsy, as the case merits. […] Obtain a testicular ultrasonogram if the serum estradiol level is elevated and the clinical examination findings suggest the possibility of a testicular neoplasm. […] Breast imaging, through mammography or ultrasonography, may be controversial, because gynecomastia is much more common than male breast cancer. […] The positive predictive value of imaging in males is 55% using mammography and 17% using ultrasonography. […] However, a study by Telegrafo et al in which ultrasonography was used to diagnosis and classify gynecomastia found the same results as when mammography was used, suggesting that ultrasonography can be employed as a primary imaging modality for determining the presence of gynecomastia and categorizing its shape.

• #37 Gynecomastia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/gynecomastia/

  Breast imaging is not routinely recommended in patients with clinical features consistent with gynecomastia or pseudogynecomastia. […] Some guidelines recommend testicular ultrasound for all individuals with gynecomastia; others recommend imaging only in the following cases: suspected testicular tumor, suspected hypogonadism, gynecomastia 5 cm, pathological gynecomastia of unknown etiology. […] If all laboratory tests are normal, including the hormone profile, gynecomastia is likely idiopathic.

• #38 Gynecomastia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/869

  Gynecomastia results from excessive estrogen action or deficient testosterone action on breast glandular tissue. […] Key diagnostic factors include palpable breast tissue, newborn age, pubertal age, older adult age, accidental medication exposure in children, substance use disorder, acne in adult males, obesity, breast pain, and small or soft testicles. […] 1st tests to order include serum TSH, serum creatinine, and serum LFTs. […] Tests to consider include serum total testosterone, serum LH, serum estradiol, serum sex hormone binding globulin (SHBG), serum free testosterone, serum beta hCG, serum dehydroepiandrosterone-sulfate (DHEAS), serum prolactin, mammogram, core biopsy of breast (if cancer suspected), testicular ultrasound, and abdominal CT/MRI (if adrenal adenoma or carcinoma suspected).

• #39 Gynecomastia – Sharp – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6806/html

  This review article provides an overview of gynecomastia based on the current available literature. […] A thorough history and physical exam remain the mainstay for diagnosis. True gynecomastia is detected on physical exam as a mobile concentric disk of firm tissue beneath the nipple-areolar complex. […] Routine laboratory testing, in the absence of suspicious history or physical examination findings, is not recommended. […] Routine imaging studies are not typically recommended for clear cases of gynecomastia and the need should be guided by physical examination and clinical history. […] A thorough history and physical is the mainstay for diagnosis of gynecomastia. […] Percutaneous biopsy is not routinely required if history and exam are consistent with gynecomastia. However, percutaneous biopsy should be considered when carcinoma is unable to be ruled out based upon clinical and imaging findings alone.

• #40 Gynaecomastia | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/breast-lumps-and-benign-not-cancer-breast-conditions/gynaecomastia/

  Gynaecomastia can be a symptom of some medical conditions. However, in most cases gynaecomastia is unlikely to be the only symptom you have. […] Its important to see your GP, who will assess your symptoms. They may refer you to a breast clinic to have tests. […] Your GP will usually be able to confirm if you have gynaecomastia. […] Occasionally your GP may refer you to a breast clinic where youll be seen by a specialist doctor or nurse. […] At the clinic youll have a breast examination. […] You may need to have other tests to make a definite diagnosis. These can include: A mammogram, An ultrasound scan, A fine needle aspiration (FNA), A core biopsy of breast tissue. […] Because gynaecomastia can be a symptom of other conditions, your specialist may want to examine other parts of your body. This may include your: Neck, Abdomen (belly), Testicles. […] They may also ask you to have further tests, such as a blood test.

• #41 Gynecomastia – Causes, Symptoms, Diagnosis, and Treatment | Medanta

  https://www.medanta.org/hospitals-near-me/gurugram-hospital/speciality/breast-cancer/disease/gynecomastia-types-symptoms-diagnosis-and-treatment

  Imaging tests like mammography or ultrasound may be used to check for any abnormalities in the breast tissue. […] If a lump is detected during imaging tests, the doctor may advice a biopsy to determine whether the tissue is cancerous or noncancerous. […] Not all cases of gynecomastia require extensive testing. […] A healthcare provider can help determine which tests are necessary based on individual symptoms and medical history. […] A healthcare provider can help diagnose and determine the appropriate treatment plan for gynecomastia based on individual symptoms and medical history.

• #42 Gynecomastia Workup: Approach Considerations

  https://emedicine.medscape.com/article/120858-workup

  Characteristic findings include proliferation of ductules and stroma (consisting of connective-tissue elements such as fibroblasts, collagen, and myofibroblasts) and occasional acini. […] Gynecomastia of short duration consists of a prominent ductular component with loose stroma. […] Long-standing gynecomastia consists of dense stroma with few ductules. […] Ramadan et al, assessing breast vascularity in 54 male patients, aged 11-27 years, with gynecomastia, concluded that vascular structures ought to be considered a component of gynecomastia. […] Using ultrasonographic scanning, the authors found a strong correlation between the progression of breast development and that of arterial and venous blood flow.

• #43 Gynecomastia Workup: Approach Considerations

  https://emedicine.medscape.com/article/120858-workup

  Characteristic findings include proliferation of ductules and stroma (consisting of connective-tissue elements such as fibroblasts, collagen, and myofibroblasts) and occasional acini. […] Gynecomastia of short duration consists of a prominent ductular component with loose stroma. […] Long-standing gynecomastia consists of dense stroma with few ductules. […] Ramadan et al, assessing breast vascularity in 54 male patients, aged 11-27 years, with gynecomastia, concluded that vascular structures ought to be considered a component of gynecomastia. […] Using ultrasonographic scanning, the authors found a strong correlation between the progression of breast development and that of arterial and venous blood flow.

• #44 Gynecomastia – Wikipedia

  https://en.wikipedia.org/wiki/Gynecomastia

  Gynecomastia is the most common benign disorder of the male breast tissue and affects 35% of men, being most prevalent between the ages of 50 and 69. […] Most occurrences of gynecomastia do not require diagnostic tests. […] To diagnose gynecomastia, a thorough history and physical examination are obtained by a physician. Important aspects of the physical examination include evaluation of the male breast tissue with palpation to evaluate for breast cancer and pseudogynecomastia (male breast tissue enlargement solely due to excess fatty tissue), evaluation of penile size and development, evaluation of testicular development and an assessment for masses that raise suspicion for testicular cancer, and proper development of secondary sex characteristics such as the amount and distribution of pubic and underarm hair.

• #45 Gynecomastia – Wikipedia

  https://en.wikipedia.org/wiki/Gynecomastia

  Diagnosis of men with breast enlargement can be evaluated using an algorithm. […] Recommended laboratory investigations to find the underlying cause of gynecomastia include tests for aspartate transaminase and alanine transaminase to rule out liver disease, serum creatinine to determine if kidney damage is present, and thyroid-stimulating hormone levels to evaluate for hyperthyroidism. […] If these initial laboratory tests fail to uncover the cause of gynecomastia, then additional tests to evaluate for an underlying hormonal balance due to hypogonadism or a testicular tumor should be checked including total and free levels of testosterone, luteinizing hormone, follicle stimulating hormone, estradiol, serum beta human chorionic gonadotropin (-hCG), and prolactin. […] High levels of prolactin are uncommon in people with gynecomastia. […] If -hCG levels are abnormally high, then ultrasound of the testicles should be performed to check for signs of a hormone-secreting testicular tumor. […] If this evaluation does not reveal the cause of gynecomastia, then it is considered to be idiopathic gynecomastia (of unclear cause).

• #46 Gynaecomastia: when and why to refer to specialist care | British Journal of General Practice

  https://bjgp.org/content/71/705/185

  If the cause of gynaecomastia is not obvious then further investigation is necessary before referral to secondary care. GPs should investigate males with: rapid breast enlargement; recent gynaecomastia onset in lean males aged 20 years; persistent painful gynaecomastia; eccentric breast mass; massive gynaecomastia in adolescents; and persistent gynaecomastia in adolescents (18 months). […] Most patients with gynaecomastia do not warrant further investigation or treatment. However, any red-flag symptoms should prompt urgent referral to the appropriate medical specialty for further investigation and treatment. […] Referral to medical endocrinology is advised in the presence of abnormal endocrine (hormonal) blood results. An abnormal AFP or -HCG, testicular ultrasound, or a testicular mass on clinical examination should prompt urgent referral to a urologist.

• #47 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Gynecomastia is a benign enlargement of the male breast (usually bilateral but sometimes unilateral) resulting from a proliferation of the glandular component of the breast. It is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. Gynecomastia should be differentiated from pseudogynecomastia (lipomastia), which is characterized by fat deposition without glandular proliferation. […] Patients with physiologic gynecomastia do not require further evaluation. Similarly, asymptomatic and pubertal gynecomastia do not require further tests and should be reevaluated in 6 months. Further evaluation is necessary in the following situations: Breast size greater than 5 cm (macromastia), A lump that is tender, of recent onset, progressive, or of unknown duration, Signs of malignancy (eg, hard or fixed lymph nodes or positive lymph node findings).

• #48 Gynecomastia Workup: Approach Considerations

  https://emedicine.medscape.com/article/120858-workup

  Patients with physiologic gynecomastia do not require further evaluation. […] Similarly, asymptomatic and pubertal gynecomastia do not require further tests and should be reevaluated in 6 months. […] Further evaluation is necessary in patients with the following: Breast size greater than 5 cm (macromastia). […] A lump that is tender, of recent onset, progressive, or of unknown duration. […] Signs of malignancy (eg, hard or fixed lymph nodes or positive lymph node findings). […] A serum chemistry panel may be helpful in evaluating for renal or liver disease. […] Free or total testosterone, luteinizing hormone (LH), estradiol, and dehydroepiandrosterone sulfate levels are used to evaluate a patient with possible feminization syndrome. […] Obtain thyroid-stimulating hormone (TSH) and free thyroxine levels if hyperthyroidism is suspected.

• #49 Enlarged breasts in men (gynecomastia) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gynecomastia/diagnosis-treatment/drc-20351799

  To find out if you have gynecomastia, a member of your health care team starts by asking you some questions. For example, you’ll likely be asked about your symptoms and any medicines you take. You’re also given a medical exam to check your breast tissue, stomach area and genitals. […] Your health care team likely will order tests. These can help find a possible cause of gynecomastia or look for conditions that can cause similar symptoms. Tests also may be done to check for breast cancer. […] Your health care team will want to be sure that your breast swelling is gynecomastia and not another condition. Other conditions that can cause similar symptoms include: […] Breast cancer is uncommon in men, but it can happen. Enlargement of one breast or the presence of a firm lump raises the concern for male breast cancer. […] Clinical features, diagnosis, and evaluation of gynecomastia in adults.

• #50 Gynecomastia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/gynecomastia-1?lang=us

  Focal gynecomastia can variably appear as a retroareolar, triangular, hypoechoic mass. […] In chronic dendritic gynecomastia, there is often a subareolar hypoechoic lesion with an anechoic star-shaped posterior border, which can be described as fingerlike projections or „spider legs” insinuating into the surrounding echogenic fibrous breast tissue. […] Pseudogynecomastia: involves breast enlargement (usually bilateral) caused by an excess of adipose tissue, which is not necessarily associated with constitutional obesity. […] Male breast cancer: unilateral fixed painless irregular hard mass may occur remotely from the areola (gynecomastia does not).

• #51 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  If no pathologic etiology is detected, then appropriate treatment is close observation. A careful breast exam should be done initially every 3-6 months until the gynecomastia regresses or stabilizes, after which a breast exam can be performed yearly. […] If the gynecomastia is severe, does not resolve, of recent onset (less than 6 months) and does not have a treatable underlying cause, some medical therapies may be attempted. There are 3 classes of medical treatment for gynecomastia: androgens (testosterone, dihydrotestosterone, danazol), anti-estrogens (clomiphene citrate, tamoxifen), and aromatase inhibitors such as letrozole and anastrozole. […] When medical therapy is ineffective, particularly in cases of longstanding gynecomastia, or when the gynecomastia interferes with the patient’s activities of daily living, or when there is suspicion of malignancy of breast, then surgical therapy is appropriate.

• #52 Gynaecomastia—pathophysiology, diagnosis and treatment | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2014.139

  Breast cancer in men is much less common than benign gynaecomastia, and the two conditions can usually be distinguished by a careful physical examination. […] In some cases, such as pubertal gynaecomastia, the breast enlargement resolves spontaneously. […] In other situations, more active treatment might be required to correct an underlying condition (such as hyperthyroidism or a benign Leydig cell tumour of the testis) or medications that could cause breast enlargement (such as spironolactone) might need to be discontinued. […] For men with hypogonadism, administration of androgens might be helpful, as might antiestrogen therapy in men with endogenous overproduction of estrogens. […] Surgery to remove the enlarged breast tissue might be necessary when gynaecomastia does not resolve spontaneously or with medical therapy.

• #53 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  If no pathologic etiology is detected, then appropriate treatment is close observation. A careful breast exam should be done initially every 3-6 months until the gynecomastia regresses or stabilizes, after which a breast exam can be performed yearly. […] If the gynecomastia is severe, does not resolve, of recent onset (less than 6 months) and does not have a treatable underlying cause, some medical therapies may be attempted. There are 3 classes of medical treatment for gynecomastia: androgens (testosterone, dihydrotestosterone, danazol), anti-estrogens (clomiphene citrate, tamoxifen), and aromatase inhibitors such as letrozole and anastrozole. […] When medical therapy is ineffective, particularly in cases of longstanding gynecomastia, or when the gynecomastia interferes with the patient’s activities of daily living, or when there is suspicion of malignancy of breast, then surgical therapy is appropriate.

• #54 Gynaecomastia: when and why to refer to specialist care | British Journal of General Practice

  https://bjgp.org/content/71/705/185

  If the cause of gynaecomastia is not obvious then further investigation is necessary before referral to secondary care. GPs should investigate males with: rapid breast enlargement; recent gynaecomastia onset in lean males aged 20 years; persistent painful gynaecomastia; eccentric breast mass; massive gynaecomastia in adolescents; and persistent gynaecomastia in adolescents (18 months). […] Most patients with gynaecomastia do not warrant further investigation or treatment. However, any red-flag symptoms should prompt urgent referral to the appropriate medical specialty for further investigation and treatment. […] Referral to medical endocrinology is advised in the presence of abnormal endocrine (hormonal) blood results. An abnormal AFP or -HCG, testicular ultrasound, or a testicular mass on clinical examination should prompt urgent referral to a urologist.

• #55 Gynaecomastia: when and why to refer to specialist care | British Journal of General Practice

  https://bjgp.org/content/71/705/185

  Referral directly to the rapid-access breast clinic is recommended if there is: any clinical suspicion of breast malignancy; persistent painful gynaecomastia (6 months) with normal blood tests; and a unilateral lump with no obvious physiological/drug-induced cause, a family history of breast cancer, or genetic predisposition (Klinefelters). […] Blood tests and imaging should be undertaken in primary care to facilitate optimal secondary care referral and management.

• #56 Gynaecomastia–pathophysiology, diagnosis and treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/25112235/

  Gynaecomastia (enlargement of the male breast tissue) is a common finding in the general population. […] Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance. […] However, the condition might cause local pain and tenderness, could occasionally be the result of a serious underlying illness or a medication, or be inherited. […] Breast cancer in men is much less common than benign gynaecomastia, and the two conditions can usually be distinguished by a careful physical examination. […] In some cases, such as pubertal gynaecomastia, the breast enlargement resolves spontaneously. […] In other situations, more active treatment might be required to correct an underlying condition (such as hyperthyroidism or a benign Leydig cell tumour of the testis) or medications that could cause breast enlargement (such as spironolactone) might need to be discontinued. […] For men with hypogonadism, administration of androgens might be helpful, as might antiestrogen therapy in men with endogenous overproduction of estrogens. […] Surgery to remove the enlarged breast tissue might be necessary when gynaecomastia does not resolve spontaneously or with medical therapy.

• #57 Gynaecomastia—pathophysiology, diagnosis and treatment | Nature Reviews Endocrinology

  https://www.nature.com/articles/nrendo.2014.139

  Gynaecomastia is a common condition and is usually benign. […] Gynaecomastia typically results from an (absolute or relative) deficiency of androgen action or excessive estrogen action in the breast tissue. […] Gynaecomastia often resolves by itself or upon removal of the underlying cause (such as medication). […] Treatment is indicated in men with symptoms (particularly pain and tenderness in the breast) and involves the use of androgens or antiestrogens. […] Surgery can be offered to selected patients when the condition does not resolve spontaneously or respond to medical treatment. […] Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance. […] However, the condition might cause local pain and tenderness, could occasionally be the result of a serious underlying illness or a medication, or be inherited.

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