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Gynaecomastia
🚨 Any discrete mass in the male breast of an older man must be considered malignant until proven otherwise → urgent referral.
📖 About
- Gynaecomastia = benign proliferation of glandular breast tissue in males 👨⚕️.
- Most cases are idiopathic, but important systemic or drug-related causes exist.
🩺 Clinical
- Often presents with tender, uncomfortable breast tissue.
- Look for evidence of pituitary tumours (visual symptoms, galactorrhoea).
- Check for hypogonadism (testicular atrophy, low libido).
📊 Commoner Causes (Summary Table)
| Cause | Clinical Clues | Key Tests | Management |
|---|---|---|---|
| 👦 Pubertal Gynaecomastia | Bilateral, adolescence, self-limiting | Clinical only | Reassurance ✅ |
| 💊 Drug-Induced | Spironolactone, cimetidine, anti-androgens | Medication history, ± serum prolactin | Stop/switch drug |
| 🧬 Hypogonadism | Testicular atrophy, ↓ libido, ED | ↓ Testosterone, ↑ FSH/LH, karyotyping (Klinefelter) | Testosterone replacement, treat cause |
| 🍺 Liver Disease | Bilateral, with jaundice/ascites | LFTs, ultrasound/CT | Treat cirrhosis & complications |
| 🔥 Hyperthyroidism | Weight loss, tachycardia, heat intolerance | TSH ↓, T4 ↑ | Antithyroid therapy, RAI, or surgery |
| 🎱 Testicular Tumours | Mass, pain, systemic features | USS, tumour markers (hCG, AFP, LDH) | Orchidectomy, oncology referral |
| 🩸 CKD | Fatigue, anaemia, oedema | Creatinine, eGFR, urinalysis | Nephrology care, dialysis, ± transplant |
🧾 Wider Causes of Gynaecomastia
- Physiological: newborn 👶, adolescence 👦, ageing 👴
- Hypogonadism (testicular failure, viral orchitis, trauma, Klinefelter’s, anorchia)
- Endocrine: thyrotoxicosis, ↑ aromatase activity
- Systemic disease: liver failure, CKD, malnutrition/starvation
- Neoplasia: testicular, adrenal, lung cancers
- Inflammatory/autoimmune: UC, RA, granulomatous disease
- Neurological/spinal: paraplegics
- Drugs 💊 (see list below)
💊 Drug Causes of Gynaecomastia
- Anti-androgenic or testosterone inhibitors: ketoconazole, spironolactone, cimetidine, cisplatin
- Oestrogens / OCPs, stilboestrol
- Cardiac drugs: digoxin, verapamil (Ca-blockers), ACE inhibitors
- CNS drugs: phenothiazines, tricyclics, diazepam, methyldopa
- Other: isoniazid, omeprazole, cyclophosphamide, busulphan, cannabis, heroin
🧪 Investigations
- Bloods: testosterone, oestradiol, FSH/LH, prolactin, hCG
- LFTs, U&E, TFTs
- Scrotal USS if testicular tumour suspected
- Breast USS ± biopsy if suspicious lump 🚨
⚕️ Management
- Treat the underlying cause
- Stop causative drugs if possible
- Hormonal therapy if hypogonadism
- Surgery (subcutaneous mastectomy) for persistent, painful, or distressing gynaecomastia
💡 Exam Tip: Tender bilateral gynaecomastia in a young man → think pubertal or drug-induced. Unilateral firm mass in an older male → always consider breast cancer until proven otherwise.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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