Makindo Medical Notes

🚨 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)

🧾 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.