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Gynecomastia
Other Resources UpToDate PubMed

Gynecomastia

Contributors: Annie Chen BS, Neil Shear MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Gynecomastia, enlargement of the breast tissue, can be a normal physiologic occurrence or be due to a disease state or medication. It is relatively common in adolescent boys.

Gynecomastia can be caused by medications or exposure to exogenous chemicals. When gynecomastia is related to medication use, the mechanism for the excessive breast tissue development is an impaired balance in the serum estrogen to serum androgen ratio, or a rise in prolactin level.

Medications with strong evidence supporting an association with gynecomastia include antiandrogens, sex hormones, spironolactone, cimetidine, verapamil, and chemotherapy (especially alkylating agents). Tricyclic antidepressants, neuroleptics, calcium channel blockers, omeprazole, sulpiride, captopril, digitalis glycosides, and some antibiotics and growth hormones have also been reported. Once the offending medication is removed, the gynecomastia will usually resolve.

Physiologic gynecomastia typically occurs during 3 phases of life: shortly after birth, puberty, and older age (60 years and older). It can occur shortly after birth due to increased fetal blood levels of estradiol and progesterone that stimulate newborn breast tissue. During puberty, the increased gonadotrophins and testosterone levels can cause gynecomastia, which typically self-resolves within 3 years.

Pathologic gynecomastia is caused by increased estrogen-to-androgen ratio either in circulation or in breast tissue. Testicular tumors, such as Leydig cell tumors, Sertoli cell tumors, and granulosa cell tumors are estrogen-secreting tumors that increase estrogen levels. Besides increased estrogen production, lower testosterone levels can also increase estrogen-to-androgen ratio, which causes gynecomastia. For example, primary hypogonadism, Klinefelter syndrome, Kallmann syndrome, and Kennedy disease are associated with an increased estrogen-to-androgen ratio.

Codes

ICD10CM:
N62 – Hypertrophy of breast

SNOMEDCT:
4754008 – Gynecomastia

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

If a medication is not clearly the cause, consider:
  • Testicular tumors (see Sex cord stromal tumor)
  • Hypothyroidism and Hyperthyroidism
  • Cushing syndrome
  • Liver disease
  • Hodgkin lymphoma
  • Androgen insensitivity syndrome
  • Klinefelter syndrome
  • Male pseudohermaphroditism
  • Testicular feminization syndrome
  • Leukemia
  • Chronic Glomerulonephritis
  • Pseudogynecomastia
  • Male breast cancer
  • Benign breast lesion (Breast abscess, intraductal cyst, papilloma, Fibroadenoma of breast, phyllodes tumor, lymphangioma, hemangioma, Lipoma)

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:10/03/2023
Last Updated:11/30/2023
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Gynecomastia
A medical illustration showing key findings of Gynecomastia
Clinical image of Gynecomastia - imageId=336348. Click to open in gallery.  caption: 'Enlarged breasts, secondary to a medication.'
Enlarged breasts, secondary to a medication.
Copyright © 2024 VisualDx®. All rights reserved.