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Gynecomastia: Differential Diagnosis of Male Breast Enlargement
Gynecomastia is defined as a benign glandular enlargement of the male breast. Gynecomastia must be distinguished from breast enlargement due to tumor or fat deposition.
Differential Diagnosis of Gynecomastia
- Newborn gynecomastia
- Gynecomastia in adolescents
Increase in Estrogens or Androgens Causes Gynecomastia
- Testicular tumors (Leydig-cell tumor, choriocarcinoma)
- Liver cirrhosis
- Abuse of anabolic steroids
Hypergonadotropic Hypogonadism may cause Gynecomastia
- Klinefelter syndrome
- Anti-androgenic therapy
- Reifenstein syndrome
- Testicular feminization
- Bilateral testicular disease or loss of testes (e.g. mumps orchitis)
Hyperprolactinemia causes Gynecomastia
- Pituitary adenomas
- Drugs (see below)
Drugs causing Gynecomastia
- Antiandrogens: bicalutamide, flutamide, cyproterone acetate
- Psychotropic drugs, cannabis
The cause of gynecomastia cannot be identified in 50%. Gynecomastia is associated with the following chronic diseases: liver cirrhosis, diabetes mellitus, tuberculosis, heart failure and renal insufficiency.
Non-glandular Male Breast Enlargement
- Obesity: combination of excessive caloric intake and lack of physical activity. Alcohol consumption increases the caloric intake.
- Tumors are rare and often one-sided: breast cancer, fibroadenoma, neurofibroma.
Diagnostic Work-up of Gynecomastia
History and Physical Examination:
- History: Risk factors for gynecomastia? Medication?
- Body weight and height
- Size of the testes
- Asymmetric or bilateral gynecomastia? Palpation: tumor?
Testosterone in serum, LH, FSH, TSH, prolactin.
Ultrasound imaging and/or mammography, if a tumor is suspected.
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Deutsche Version: Differentialdiagnose der Gynäkomastie