Gynaecomastia.

 

Male breast hyperplasia.

  • Physiological.
  • Neonatal – witches milk.
  • Pubertal – often unilateral, lasts 1 year.
  • Senile.
  • Obesity – fat and more androgen to oestrogen.

 

Pathological.

  • Drugs.
  • Testicular failure.
  • Endocrine.
  • Tumours.
  • Liver disorders.

 

Red flags.

  • Pain.
  • Sudden increase.
  • Galactorrhoea.

 

Drugs.

Hormonal drugs.

  • Oestrogen
  • Cyproterone ( prostatic ca.).
  • Testosterone – increased conversion.

CVS.

  • Ca++ -.
  • Spironolactone
  • ACE -
  • Amiodarone
  • Digoxin

CNS.

  • Cannibis
  • Opiates
  • TCAD
  • DE- (metoclopramide, phenothiazine).

GIT.

  • Cimetidine

Alcohol.

Anti-infectives.

  • Metronidazole
  • Ketoconazole

Testicular failure.

  • 46XY.
  • 47XXY.Only premalignant state in gynaecomastia.
  • Post orchitis.
  • Post orchidectomy.

Endocrine.

  • Hyperprolactinaemia
  • Cushings
  • Hyperthyroidism
  • Refeeding syndrome
  • Acromegaly

Tumours.

  • Oestrogen secreting (liver, adrenal).
  • hcG secreting (testicular).
  • Breast tumour.

Liver.

Cirrhosis.Causes more conversion of androgen to oestrogen. testicular atrophy. Oestrogen production.

Tests.

  • TFTs.
  • Testosterone.
  • Oestrogen.
  • Prolactin.
  • LH and FSH.
  • LFTs.
  • Testicular US.
  • Adrenal US.
  • Breast Bx.