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JohnsonMD and M. Address correspondence to M. Abstract Gynecomastia, defined as benign proliferation of male breast glandular tissue, is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications.
Although a fairly common presentation in the primary care setting and mostly of benign etiology, it can cause patients considerable anxiety.
The initial step is to rule out pseudogynecomastia by careful history taking and physical examination. A stepwise approach that includes imaging and laboratory testing to exclude neoplasms and endocrinopathies may facilitate cost-effective diagnosis. If results of all studies are normal, idiopathic gynecomastia is diagnosed.
The evidence in this area is mainly of observational nature and lower quality. Gynecomastia is defined as benign proliferation of male breast glandular tissue. The evaluation and management perspectives presented in this article do not pertain to physiologic neonatal and adolescent cases but rather to symptomatic adults who are concerned and seek evaluation and treatment.
Although breast cancer is rare in men, those with gynecomastia often become anxious and seek medical attention, making this presentation fairly common in primary care settings. Diagnostic evaluation of these cases can be costly and involves laboratory and radiographic testing; therefore, a diagnostic algorithm that facilitates step-by-step evaluation may be cost-effective and reduce the associated patient anxiety.
This article describes the pathophysiology and common mechanisms and causes of benign gynecomastia and introduces a diagnostic algorithm to facilitate evaluation and management of symptomatic cases that present in primary care settings.
Levels of free serum testosterone are decreased in patients with gonadal failure, which can be primary Klinefelter syndrome, mumps orchitis, castration or secondary hypothalamic and pituitary disease.
Androgen resistance syndromes due to impaired activity of enzymes involved in the biosynthesis of testosterone can also be associated with gynecomastia. However, free testosterone levels in these patients are lower than those of controls without gynecomastia.
Examination of these patients reveals diffuse breast enlargement without a subareolar palpable nodule. These patients do not need additional work-up and only require reassurance. Gynecomastia is usually bilateral, 39 but patients may present with asymmetrical or unilateral findings.
Palpation usually demonstrates a palpable, tender, firm, mobile, disclike mound of tissues 14 that is not as hard as breast cancer and is located centrally under the nipple-areolar complex. When palpable masses are unilateral, hard, fixed, peripheral to the nipple, and associated with nipple discharge, skin changes, or lymphadenopathy, breast cancer should be suspected and thorough evaluation is recommended.
Anthropometric measurements eg, body mass index may also be helpful because obesity can be associated with increased peripheral conversion of androgens to estrogens and is associated with a higher prevalence of gynecomastia. History may also reveal a clear and temporal association with a causative drug and obviate the need for extensive and costly evaluation.
If the association with a drug is unclear, then evaluation is recommended. Table 2 depicts the numerous medications that have been associated with gynecomastia. It has also been associated with the use of alcohol and illicit drugs, such as marijuana, heroin, methadone, and amphetamines.Gynecomastia, defined as benign proliferation of male breast glandular tissue, is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications.
Although a fairly common presentation in the primary care setting and mostly of benign etiology, it. A Detailed Explanation of Gynecomastia testes should be examined for asymmetric enlargement in Klinefelter's syndrome.
The doctor may consider liver function tests of a karyotype if Kleinfelter's is suspected/5(3). Home» World Literature» A Detailed Explanation of Gynecomastia A Detailed Explanation of Gynecomastia Gynecomastia is a common disease of the male breast where there is a benign glandular enlargement of that breast at some time in the male's life.
Gynecomastia definition: a condition of overdevelopment of a male's breasts | Meaning, pronunciation, translations and examples Definition of 'gynecomastia' Word Frequency. gynecomastia in American Whether you're in search of a crossword puzzle, a detailed guide to tying knots, or tips on writing the perfect college essay, .
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