eMedicine Specialties > Endocrinology > Gonads

Gynecomastia: Differential Diagnoses & Workup

Author: Mark R Allee, MD, Associate Professor, Department of Medicine, University of Oklahoma Health Sciences Center
Coauthor(s): Mary Zoe Baker, MD, Professor, Department of Medicine, Section of Endocrinology, Metabolism and Hypertension, University of Oklahoma; Medical Director, University of Oklahoma Physicians, Medicine Specialty Clinic, General Medicine Clinic and Medicine Residents' Clinic
Contributor Information and Disclosures

Updated: Sep 23, 2009

Differential Diagnoses

Breast Cancer
Dermoid Cyst
Hypogonadism
Lymphangioma

Other Problems to Be Considered

Hematoma
Lipoma
Male sexual dysfunction
Neurofibroma

Workup

Laboratory Studies

  • Patients with physiologic gynecomastia do not require further evaluation.
  • Further evaluation is necessary in patients with the following:
    • Breast size greater than 5 cm (macromastia)
    • A lump that is tender, of recent onset, progressive, or of unknown duration
    • Signs of malignancy (eg, hard or fixed lymph nodes or positive lymph node findings)
  • A serum chemistry panel may be helpful in evaluating for renal or liver disease.
  • Free or total testosterone, luteinizing hormone (LH), estradiol, and dehydroepiandrosterone sulfate levels are used to evaluate a patient with possible feminization syndrome.
  • Obtain thyroid-stimulating hormone (TSH) and free thyroxine levels if hyperthyroidism is suspected.

Imaging Studies

  • Order a mammogram if 1 or more features of breast cancer are apparent upon clinical examination.7 This can be followed by fine-needle aspiration or breast biopsy, as the case merits.8,9
  • Obtain a testicular ultrasonogram if the serum estradiol level is elevated and the clinical examination findings suggest the possibility of a testicular neoplasm.

Other Tests

Asymptomatic and pubertal gynecomastia do not require further tests and should be reevaluated in 6 months.

Histologic Findings

Characteristic findings include proliferation of ductules and stroma (consisting of connective-tissue elements such as fibroblasts, collagen, and myofibroblasts) and occasional acini. Gynecomastia of short duration consists of a prominent ductular component with loose stroma. Long-standing gynecomastia consists of dense stroma with few ductules.

More on Gynecomastia

Overview: Gynecomastia
Differential Diagnoses & Workup: Gynecomastia
Treatment & Medication: Gynecomastia
Follow-up: Gynecomastia
References
Further Reading
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References

  1. Glass AR. Gynecomastia. Endocrinol Metab Clin North Am. Dec 1994;23(4):825-37. [Medline].

  2. Braunstein GD. Gynecomastia. N Engl J Med. Feb 18 1993;328(7):490-5. [Medline].

  3. Mahoney CP. Adolescent gynecomastia. Differential diagnosis and management. Pediatr Clin North Am. Dec 1990;37(6):1389-404. [Medline].

  4. Mauras N. Treatment of adolescents with gynecomastia. J Pediatr. Apr 2005;146(4):576; author reply 576-7. [Medline].

  5. Thompson DF, Carter JR. Drug-induced gynecomastia. Pharmacotherapy. Jan-Feb 1993;13(1):37-45. [Medline].

  6. Eckman A, Dobs A. Drug-induced gynecomastia. Expert Opin Drug Saf. Nov 2008;7(6):691-702. [Medline].

  7. Mathew J, Perkins GH, Stephens T, et al. Primary breast cancer in men: clinical, imaging, and pathologic findings in 57 patients. AJR Am J Roentgenol. Dec 2008;191(6):1631-9. [Medline].

  8. Volpe CM, Raffetto JD, Collure DW, et al. Unilateral male breast masses: cancer risk and their evaluation and management. Am Surg. Mar 1999;65(3):250-3. [Medline].

  9. MacIntosh RF, Merrimen JL, Barnes PJ. Application of the probabilistic approach to reporting breast fine needle aspiration in males. Acta Cytol. Sep-Oct 2008;52(5):530-4. [Medline].

  10. Plourde PV, Kulin HE, Santner SJ. Clomiphene in the treatment of adolescent gynecomastia. Clinical and endocrine studies. Am J Dis Child. Nov 1983;137(11):1080-2. [Medline].

  11. Bedognetti D, Rubagotti A, Conti G, et al. An open, randomised, multicentre, phase 3 trial comparing the efficacy of two tamoxifen schedules in preventing gynaecomastia induced by bicalutamide monotherapy in prostate cancer patients. Eur Urol. May 19 2009;[Medline].

  12. Boccardo F, Rubagotti A, Battaglia M, et al. Evaluation of tamoxifen and anastrozole in the prevention of gynecomastia and breast pain induced by bicalutamide monotherapy of prostate cancer. J Clin Oncol. Feb 1 2005;23(4):808-15. [Medline].

  13. Jones DJ, Holt SD, Surtees P, et al. A comparison of danazol and placebo in the treatment of adult idiopathic gynaecomastia: results of a prospective study in 55 patients. Ann R Coll Surg Engl. Sep 1990;72(5):296-8. [Medline]. [Full Text].

  14. Colombo-Benkmann M, Buse B, Stern J, et al. Indications for and results of surgical therapy for male gynecomastia. Am J Surg. Jul 1999;178(1):60-3. [Medline].

  15. Davanco RA, Sabino Neto M, Garcia EB, et al. Quality of life in the surgical treatment of gynecomastia. Aesthetic Plast Surg. Oct 25 2008;[Medline].

  16. Ridha H, Colville RJ, Vesely MJ. How happy are patients with their gynaecomastia reduction surgery?. J Plast Reconstr Aesthet Surg. Aug 28 2008;[Medline].

  17. Benito-Ruiz J, Raigosa M, Manzano M, et al. Assessment of a suction-assisted cartilage shaver plus liposuction for the treatment of gynecomastia. Aesthet Surg J. Jul-Aug 2009;29(4):302-9. [Medline].

  18. Hammond DC. Surgical correction of gynecomastia. Plast Reconstr Surg. Jul 2009;124(1 Suppl):61e-68e. [Medline].

  19. Fan L, Yang X, Zhang Y, et al. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: a report of 65 cases. Surg Laparosc Endosc Percutan Tech. Jun 2009;19(3):e85-90. [Medline].

  20. Gruntmanis U, Braunstein GD. Treatment of gynecomastia. Curr Opin Investig Drugs. May 2001;2(5):643-9. [Medline].

  21. Braunstein GD, Glassman HA. Gynecomastia. Curr Ther Endocrinol Metab. 1997;6:401-4. [Medline].

  22. Neuman JF. Evaluation and treatment of gynecomastia. Am Fam Physician. Apr 1997;55(5):1835-44, 1849-50. [Medline].

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Further Reading

Related eMedicine topics:
 Breast Embryology
Breast Reduction, Liposuction Only
Disorders of the Breast
Gynecomastia [Plastic Surgery]
Klinefelter Syndrome
Prepubertal Testicular and Paratesticular Tumors

Clinical guidelines:
Practice advisory on liposuction. American Society of Plastic Surgeons - Medical Specialty Society. 2004 Apr. 13 pages. NGC:004125

Clinical trials:
Adaptation Among Adolescents and Adults With Klinefelter Syndrome

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Keywords

gynecomastia, male breast, male breasts, gynecomastia surgery, male breast reduction, male breast cancer, gynecomastia treatment, gynecomastia cure, gynaecomastia, pseudogynecomastia, enlargement of the male breast, male breast surgery, male breast reduction surgery, breast lump, physiologic gynecomastia, pathologic gynecomastia, testicular neoplasm, lipomastia, macromastia, pubertal gynecomastia, florid gynecomastia, fibrous gynecomastia, feminization, granular glandular tissue, breast cancer, hypogonadism, Kallmann syndrome, Klinefelter syndrome, congenital anorchia, testicular trauma, testicular torsion, viralorchitis, pituitary tumor, hypopituitarism, renal failure, kidney failure, androgen insensitivity syndrome, 5-alpha-reductase deficiency syndrome, altered estrogen-androgen balance, mumps, sexual dysfunction, infertility, chronic liver disease, thyroid disease, renal disease, eunuchoid habitus, testicular tumors, extragonadal germ cell tumors, malnutrition, hyperthyroidism, adrenal tumors, familial gynecomastia

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Contributor Information and Disclosures

Author

Mark R Allee, MD, Associate Professor, Department of Medicine, University of Oklahoma Health Sciences Center
Mark R Allee, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Mary Zoe Baker, MD, Professor, Department of Medicine, Section of Endocrinology, Metabolism and Hypertension, University of Oklahoma; Medical Director, University of Oklahoma Physicians, Medicine Specialty Clinic, General Medicine Clinic and Medicine Residents' Clinic
Mary Zoe Baker, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Chemical Society, and American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Barry J Goldstein, MD, PhD, Director, Division of Endocrinology, Diabetes and Metabolic Diseases, Professor, Department of Internal Medicine, Thomas Jefferson University
Barry J Goldstein, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Yoram Shenker, MD, Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison
Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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