GYNECOMASTIA

GYNECOMASTIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. Is there a history of drug ingestion? Digitalis, phenothiazine, amphetamine, marijuana, and many other drugs may cause gynecomastia.
2. Is there a testicular mass? Leydig's cell and Sertoli's cell tumors of the testicle may cause gynecomastia.
3. Are there abnormal secondary sex characteristics? Klinefelter's syndrome, male pseudohermaphroditism, and testicular feminization syndrome may cause gynecomastia.
4. Is there a bronze skin? If there is a bronze skin, one should consider hemochromatosis, as this may be associated with gynecomastia.
5. Are there other endocrine abnormalities? Cushing's syndrome, Addison's syndrome, and hyperthyroidism may cause gynecomastia.
6. Are there abnormalities on neurologic examination? Myotonic dystrophy, paraplegias of various types, and Friedreich's ataxia are among the many neurologic disorders that may be associated with gynecomastia.

DIAGNOSTIC WORKUP

A urine drug screen and thyroid profile should be done at the outset. Liver function studies, liver biopsy, and serum iron and iron-binding capacity will help rule out hemochromatosis and cirrhosis of the liver. A serum FSH, LH, HCG, and estradiol will help diagnose testicular tumors, Klinefelter's syndrome, and testicular feminization syndrome. Further evidence of Klinefelter's syndrome is obtained by a buccal smear (Barr bodies). Normal gonadotropin and sex hormone levels make serious pathology unlikely. A serum cortisol, cortisol suppression test, and rapid adrenocorticotropic hormone (ACTH) test will help diagnose Cushing's syndrome and Addison's disease. There is a specific beta-HCG assay that can be done to rule out an HCG-secreting tumor such as carcinoma of the lung.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

More About Gynecomastia

• Back to disease: Gynecomastia: Introduction
• Next Book Extract About Gynecomastia: BREAST DISCHARGE (Algorithmic Diagnosis of Symptoms and Signs)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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