Any discrete mass in the male breast of an older male must be considered malignant and needs urgent referral.
About
- Glandular breast tissue growth in the male
- Most cases idiopathic
Clinical
- Often tender and uncomfortable male breast tissue
- Look for evidence of pituitary tumour
- Assess for signs of hypogonadism
Causes of Gynaecomastia
- Physiological: newborn, adolescence, aging
- Deficient production/action of testosterone
- Congenital anorchia
- Klinefelter's syndrome
- Testicular feminization
- Defects in synthesis
- Testicular failure (e.g. viral orchitis, trauma, castration)
- Neurological & granulomatous diseases
- Renal failure
- Increased oestrogen production/secretion
- Increased substrate for peripheral aromatase
- Increased peripheral aromatase
- True hermaphrodite
- Lung/testicular cancer
- Adrenal/liver disease
- Starvation
- Thyrotoxicosis
- Haemodialysis, after starvation
- Paraplegics
- Ulcerative colitis
- Rheumatoid
- Trauma
Drug causes of Gynaecomastia
- Inhibitors of testosterone synth/action (e.g. Ketoconazole, Metronidazole, cimetidine, cisplatin)
- Spironolactone (not danazol)
- Oestrogens
- OCP
- Stilboestrol
- Digoxin
- Cannabis
- Griseofulvin
- Gonadotrophins inc. prolactin secretion
- Phenothiazines
- Reserpine
- Isoniazid
- Methyldopa
- Metoclopramide
- Tricyclic antidepressants
- Isoniazid
- Diazepam
- Ca blockers
- ACEi
- Busulphan
- Omeprazole
- Heroin
- Cyclophosphamide
- Diamorphine
- Marijuana
Investigations
- Where the cause is not drug-related or physiological
- Testosterone, Oestradiol, FSH/LF, Prolactin, hCG
- LFTs, U&E, TFTs
- Testicular USS may be needed
- Breast assessment and biopsy if tumour suspected
Management
- Treatment of the underlying cause
- Surgery may be indicated