Sandbox: HS

Diseases	Laboratory Findings			Physical Examination					History and Symptoms
	Estrogen-to-androgen ratio	Cholesterol levels	WBC count	Tenderness	Enlargement	Nipple discharge	Lymphadenopathy	Other physical exam findings	Age of onset	Medication intake
Gynecomastia	↑			+/-	+			Round discrete mass felt under areola and usually bilateral.	Physiological gynecomastia is seen in newborns, adolescents and elderly	Pharmacological gynecomastia has hx of medication intake.
Pseudo gynecomastia				+/-	+			Increased adipose rather than glandular tissue on examination.
Breast Cancer				+/-; mostly painless	+	+	+	Usually painless mass	Middle age to elderly
Lipoma		↑		+/-	+			Soft and mobile.	Middle age to elderly
Sebaceous cyst					+			Asymmetric enlargement and swelling feels closer to the skin.
Mastitis			+	Tender	+/-	+/-	+/-	Systemic clinical features of infection.

Ductal hyperplasia, source:https://librepathology.org

ABC

def

DRUGS	MOA	SIDE
SDFA	SDFA	DSFA

papichul

Based on the androgen and estrog imabalance
Decreased testosterone	Increased estrogen

Based on the androgen and estrogen balance

• Decreased Testosterone

• Androgen-insensitivity syndrome
• Congenital anorchia
• Five alpha-reductase deficiency
• Hypopituitarism
• Kallman Syndrome
• Klinefelter Syndrome
• Renal Failure
• Testicular trauma
• Torsion of the testes
• Viral orchitis

• Increased Estrogens

• Adrenal cancer
• Chronic liver disease
• Extragonadal germ cell tumors
• Familial gynecomastia
• Hyperthyroidism
• Kidney carcinoma
• Liver cancer
• Lung carcinoma
• Malnutrition
• Other gastrointestinal (GI) tract carcinoma
• Stomach cancer
• Testicular cancer

references

{{{ stimulatory action }}}

{{{ Breast Tissue }}}

Inhibitory action

Right coronary artery

Androgens

Estrogen

Brachiocephalic a

R common carotid a

R subclavian a

L common carotid a

Internal carotid a

External carotid a

L subclavian a

Axillary a

Int. thoracic a

Progesterone (Thorax)

Bronchial as

Growth hormone and IGF-1

Celiac a

L gastric a

Common hepatic a

Splenic a

SMA

Renal as