A dynamic approach to gynaecomastia

Introduction: Gynaecomastia is characterized by enlargement of the male breast, caused by glandular proliferation and fat deposition. Although a fairly common presentation in the primary care setting and is mostly of benign etiology, it can cause patient considerable anxiety. Sometimes it could be due to serious underlying illness or a medication or inherited. Breast cancer risk is slightly higher in males with gynaecomastia. Aim: To determine the prevalence, pathophysiology, etiology and therapy of gynaecomastia. A stepwise approach that includes imaging and laboratory testing to exclude neoplasms and endocrinopathies. Materials and Methods: A one year prospective study of twenty four gynaecomastia cases was done. A detailed clinical history taken and physical examination was done. Laboratory investigations like hepatic, renal and thyroid function tests, hormonal levels like serum estradiol, testosterone, follicular stimulating & luteinizing hormone levels, prolactin, human chorionic gonadotropin and dehydroepiandrosterone levels were done. Other investigating aids like MRI and ultrasonography, mammography, cytogenetics were useful in some of them. However, histopathology proved to be gold standard. Results: We had twenty four cases of gynaecomastia of which there were one case of Klinefelter syndrome, five cases each of idiopathic gynaecomastia, two case each of true hermaphroditism, one case each of androgen insensitivity syndrome, Ehlers danlos syndrome, cirrhosis, drug induced, renal failure, hyperthyroidism, testicular torsion, androgen insensitivity syndrome, choriocarcinoma, pituitary adenoma, adrenal neoplasm and Leydig cell tumour. Six cases were those of physiological gynaecomastia. Conclusions: Gynaecomastia is a common condition that may be attributable to an oestrogen /androgen imbalance caused by several etiological factors. After confirming the diagnosis, searching for a specific cause and classifying the case according to severity grade, the therapy for gynaecomastia should be personalized. Lifestyle guidance, reassurance, medical treatment and surgical correction are valid tailored therapeutic options.