Gynecomastia overview: Difference between revisions
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==Overview== | ==Overview== | ||
Gynecomastia is a benign male breast enlargement. The condition occurs due to increase estrogen to androgen ratio which can be physiological such as seen during infancy, puberty and old age or it can be pathological which is due to obesity, steroid use, pharmacologic agents, medical conditions including chronic liver and renal failure or hypogonadism. However, most of the gynecomastia is idiopathic and asymptomatic. The diagnosis is mainly clinical and also involves lab investigations involving blood hormone levels, renal and liver function tests and imaging involving ultrasound or mammography. The treatment is generally supportive, antiestrogens and surgical interventions, when required. | |||
==Historical Perspective== | ==Historical Perspective== | ||
Revision as of 20:02, 18 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Gynecomastia is a benign male breast enlargement. The condition occurs due to increase estrogen to androgen ratio which can be physiological such as seen during infancy, puberty and old age or it can be pathological which is due to obesity, steroid use, pharmacologic agents, medical conditions including chronic liver and renal failure or hypogonadism. However, most of the gynecomastia is idiopathic and asymptomatic. The diagnosis is mainly clinical and also involves lab investigations involving blood hormone levels, renal and liver function tests and imaging involving ultrasound or mammography. The treatment is generally supportive, antiestrogens and surgical interventions, when required.
Historical Perspective
Gynecomastia is derived from Greek words; gyne means woman and mastos, breast. The term was originally coined by Galen, a Greek physician. Gynecomastia has been a known entity since the days of Aristotle.
Classification
Gynecomastia has been classified by various systems mainly based on surgical management, the severity of gynecomastia, physical appearance, and etiology. Breast size and ptosis are the most commonly included features.
Pathophysiology
The main pathophysiology behind gynecomastia is the result of increased estrogen to androgen ratio which can occur through multiple mechanisms that can be physiological, pathological or use of certain medications.
Causes
Common known causes of gynecomastia include physiological, use of medications and pathological (cirrhosis, hyperthyroidism, testicular tumors and hypogonadism). Less common causes include androgen insensitivity syndrome, Kallmann syndrome, testosterone pathway defects and other tumors.
Differentiating gynecomastia from other diseases
Gynecomastia must be differentiated from pseudo gynecomastia and breast cancer.
Epidemiology and Demographics
Gynecomastia has the highest prevalence in elderly and neonatal age. Gynecomastia has trimodal age distribution with no racial preference.
Risk Factors
Common risk factors in the development of gynecomastia include the use of medications, cirrhosis, and hyperthyroidism. The less common risk factors include aromatase overexpression, androgen insensitivity syndrome and testosterone pathway defects.
Screening
Gynecomastia is not routinely screened.
Natural History, Complications, and Prognosis
If left untreated patients with gynecomastia may progress to develop psychosocial stresses and rarely breast cancer. The majority of physiological gynecomastia is self-limited. Secondary gynecomastia has an excellent prognosis and responds well to treatment.
Diagnosis
Diagnostic Criteria
The diagnosis of gynecomastia is based on the history, clinical examination, and exclusion of other conditions like pseudo gynecomastia and breast cancer.
History and Symptoms
The hallmark of gynecomastia is breast enlargement.The majority of patients with gynecomastia are asymptomatic. The most common symptom is pain. Less common symptoms depend on the underlying cause.
Physical Examination
Patients with gynecomastia are usually asymptomatic. Common physical examination findings of gynecomastia include breast enlargement and tenderness.
Laboratory Findings
Gynecomastia which is recent in onset and tender on the examination should have serum concentrations of human chorionic gonadotropin (hCG), LH, testosterone, and estradiol measured.
Electrocardiogram
There are no ECG findings associated with gynecomastia.
X-ray
X ray is not routinely done in gynecomastia.
CT scan
CT scan is not routinely done in gynecomastia.
MRI
MRI is not routinely done in gynecomastia.
Ultrasound
Ultrasound can be done in gynecomastia when physical findings of a patient raise suspicion of a lump, abscess or breast cancer.
Other Imaging Findings
Mammogram can be done in gynecomastia when physical findings of a patient raise suspicion of breast cancer.
Other Diagnostic Studies
Other diagnostic study in the work up for gynecomastia include biopsy, which helps to confirm the diagnosis of breast cancer.
Treatment
Medical Therapy
Gynecomastia is usually a self-limited condition, reassurance and follow-up are recommended. Causative medications or underlying condition, if found should be addressed. Pharmacologic therapy is beneficial for the first several months until fibrous tissue replaces the glandular tissue. Pharmacologic options include SERMs, androgens and aromatase inhibitors.
Surgery
Surgery is not the first-line treatment option for patients with gynecomastia.Surgery is usually reserved for patients with either psychological stresses, extensive gynecomastia or failure of medical treatment. The type of surgical technique depends on the extent of gynecomastia.
Primary Prevention
There are no established methods for the primary prevention of gynecomastia.
Secondary Prevention
There are no established methods for the secondary prevention of gynecomastia.