The anamnesis (medical history) represents an important component in the diagnosis of gynecomastia (breast enlargement). Family history Are there several men in the family who suffer from gynecomastia? Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). When did the breast change become apparent? Is the change unilateral or bilateral? Is the breast sensitive to … Gynecomastia: Medical History
The diagnosis of gynecomastia is a diagnosis of exclusion! Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Klinefelter syndrome – a numerical chromosomal aberration (aneuploidy) of the sex chromosomes occurring only in boys or men, which is manifested mainly by tall stature and testicular hypoplasia (testes too small ) – caused by hypogonadotropic hypogonadism(hypofunction of gonads). … Gynecomastia: Or something else? Differential Diagnosis
The following are the most important diseases or complications that can be caused by gynecomastia (breast enlargement): Neoplasms – Tumor diseases (C00-D48). Mammary carcinoma (breast cancer) – the relative risk is increased with gynecomastia, but the absolute risk is low
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height [obesity (overweight)]; furthermore: Inspection (viewing). Skin and mucous membranes Inspection and palpation (palpation) of the mammae (mammary glands) [exclusion of lipomastia (form of pseudogynecomastia occurring in obese men; enlargement of the breast … Gynecomastia: Examination
Laboratory parameters of the 1st order – obligatory laboratory tests. LH* FSH* Prolactin* Estradiol* Testosterone* (hypogonadism?) Sex hormone binding globulin* (SHBG). Dehydroepiandrosterone sulfate* (DHEAS) Thyroid parameters – TSH (thyroid-stimulating hormone) – exclusion of hyperthyroidism (hyperthyroidism); this induces the peripheral conversion of testosterone to estrogens. Liver parameters* – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), … Gynecomastia: Test and Diagnosis
Therapeutic target Regression of gynecomastia. Therapy recommendations Therapy for gynecomastia consists of therapy for the underlying condition. Review of permanent medication due topossible effect on the existing disease; or discontinuation, the substances associated with gynecomastia (then observant waiting). Before the age of 15: educate and observe! Drug therapy (tamoxifen (antiestrogen); testolactone (aromatase inhibitor)) should be … Gynecomastia: Drug Therapy
Optional medical device diagnostics – depending on the results of the history, physical examination, and obligatory laboratory parameters – for differential diagnostic clarification. Breast ultrasonography (ultrasound examination of the breast; breast ultrasound) using a high-resolution linear transducer – for sizing and follow-up [differentiation of glandular and adipose tissue]Note: In the case of pubertal gynecomastia, further … Gynecomastia: Diagnostic Tests
Surgical procedures should be used only in patients with long-standing gynecomastia that is not spontaneously regressive (receding) or regressive with medication [EAA Leilinie]. Subcutaneous mastectomy (surgical removal of the mammary gland body without the skin, nipple, and areola)* is required when: Gynecomastia does not regress after puberty (<5% persist) and there is a resulting distress … Gynecomastia: Surgical Therapy
To prevent gynecomastia (breast enlargement), attention must be paid to reducing individual risk factors.Behavioral Risk Factors Drug use Cannabis (hashish and marijuana) Use of shampoos, soaps, lotions, balms, gels, etc. containing lavender/tea tree oil cause gynecomastia in prepubertal boys; cause: ingredients have estrogen-like effect Eucalyptol, terpin-4-ol, dipentene/limonene, and alpha-terpineol were present in both lavender and … Gynecomastia: Prevention
The following symptoms and complaints may indicate gynecomastia (breast enlargement): Leading symptoms Mammary gland tissue > 4 cm in diameter, unilateral/bilateral. Sensitivity to touch Warning signs (red flags) Anamnestic information: Puberty + testes of different size → think of: Testicular tumor Alcohol abuse (alcohol dependence) → think of: Liver cirrhosis (irreversible damage to the liver … Gynecomastia: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Growth and differentiation of the male mammary gland is stimulated by estradiol via estrogen receptors. Inhibitory effects are exerted by testosterone via androgen receptors. True gynecomastia is caused by excessive estrogen action or a disturbed balance between androgen and estrogen supply or action. This results in hypertrophy of the male mammary … Gynecomastia: Causes