Gynaecomastia

The pathophysiological process of gynaecomastia involves an imbalance between free estrogen and free androgen action in the breast tissue.

Evaluation

Once the diagnosis of gynaecomastia is established, it is important to review all medications, including over the counter drugs such as herbal products.

• Spironolactone
• Cimetidine
• Alcohol
• Marijuana
• Estrogen/anti-testosterone

Other causes that need to be considered and the investigations:

• hcG - increased in testicular tumour.

• Increased LH with decreased Testosterone - primary hypogonadism.

• Normal or decreased LH with decreased testosterone - prolactin secreting tumour or secondary hypogonadism ( check prolactin level )

• Increased LH and testosterone - Hyperthyroidism/androgen resistance ( check TFT )

• Normal or decreased LH and increased estridiol - Sertoli-Leydig's cell neoplasm or adrenal neoplasm

• Normal hcG, testosterone, estridiol and LH - idiopathic gynaecomastia