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Review
. 2009 Nov;84(11):1010-5.
doi: 10.1016/S0025-6196(11)60671-X.

Gynecomastia: pathophysiology, evaluation, and management

Ruth E Johnson  1 , M Hassan Murad
Affiliations
Review

Gynecomastia: pathophysiology, evaluation, and management

Ruth E Johnson et al. Mayo Clin Proc. 2009 Nov.

Abstract

Gynecomastia, defined as benign proliferation of male breast glandular tissue, is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications. Although a fairly common presentation in the primary care setting and mostly of benign etiology, it can cause patients considerable anxiety. The initial step is to rule out pseudogynecomastia by careful history taking and physical examination. A stepwise approach that includes imaging and laboratory testing to exclude neoplasms and endocrinopathies may facilitate cost-effective diagnosis. If results of all studies are normal, idiopathic gynecomastia is diagnosed. The evidence in this area is mainly of observational nature and lower quality.

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Figures

FIGURE.
FIGURE.
Diagnostic algorithm for gynecomastia. CT = computed tomography; E2 = estradiol; hCG = human chorionic gonadotropin; LFT = liver function test; LH = luteinizing hormone; Prl = prolactin; T = testosterone; TSH = thyroid-stimulating hormone; US = ultrasonography. Adapted from N Engl J Med.
See this image and copyright information in PMC

Comment in

  • Radiation therapy for gynecomastia.
    Luh JY, Harmon MW, Eng TY. Luh JY, et al. Mayo Clin Proc. 2010 Apr;85(4):398-9; author reply 399. doi: 10.4065/mcp.2009.0745. Mayo Clin Proc. 2010. PMID: 20360300 Free PMC article. No abstract available.

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