STUDY - Technical - New Dacian's Medicine
Gynecomastia
(Classical / Allopathic Medicine)
Occurring only in
males, gynecomastia refers to increased breast size due to
excessive mammary gland development. This change in breast
size may be barely palpable or immediately obvious. Usually
bilateral, gynecomastia may be associated with breast
tenderness and milk secretion.
Normally, several
hormones regulate breast development. Estrogens, growth
hormones, and corticosteroids stimulate ductal growth, and
progesterone and prolactin stimulate the growth of the
alveolar lobules. Although the pathophysiology of gynecomastia
isn't fully understood, a hormonal imbalance - particularly a
change in the estrogen-androgen ratio and an increase in
prolactin - is a likely contributing factor. This explains why
gynecomastia commonly results from the effects of estrogens
and other drugs. It may also result from a hormone-secreting
tumor or from an endocrine, genetic, hepatic, or adrenal
disorder. Physiologic gynecomastia may occur in neonatal,
pubertal, and elderly males because of normal fluctuations in
hormone levels.
HISTORY:
Ask the patient when he first noticed his breast enlargement. How old was he at the time?
Ask the patient whether his breasts have become progressively larger or smaller or whether they've stayed the same.
Ask the patient if he has breast tenderness or discharge.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about associated signs and symptoms, such as a testicular mass or pain, loss of libido decreased potency, and loss of chest, axillary, or facial hair.
Ask the patient when he first noticed his breast enlargement. How old was he at the time?
Ask the patient whether his breasts have become progressively larger or smaller or whether they've stayed the same.
Ask the patient if he has breast tenderness or discharge.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about associated signs and symptoms, such as a testicular mass or pain, loss of libido decreased potency, and loss of chest, axillary, or facial hair.
PHYSICAL
ASSESSMENT:
Examine the breasts, noting asymmetry, dimpling, abnormal pigmentation, or ulceration.
Inspect the testicles for size and symmetry. Then palpate them to detect nodules, tenderness, or unusual consistency.
Look for normal penile development after puberty, and note hypospadias if present.
Examine the breasts, noting asymmetry, dimpling, abnormal pigmentation, or ulceration.
Inspect the testicles for size and symmetry. Then palpate them to detect nodules, tenderness, or unusual consistency.
Look for normal penile development after puberty, and note hypospadias if present.
SPECIAL
CONSIDERATIONS:
To make the patient as comfortable as possible, apply cold compresses to his breasts, and administer an analgesic. Prepare him for diagnostic tests, including chest and skull X-rays and blood hormone levels.
To make the patient as comfortable as possible, apply cold compresses to his breasts, and administer an analgesic. Prepare him for diagnostic tests, including chest and skull X-rays and blood hormone levels.
PEDIATRIC
POINTERS:
In neonates, gynecomastia may be associated with galactorrhea. This sign usually disappears within a few weeks but may persist until age 2.
Most males have physiologic gynecomastia at some time during adolescence, usually around age 14. This gynecomastia is usually asymmetrical and tender; it commonly resolves within 2 years and rarely persists beyond age 20.
In neonates, gynecomastia may be associated with galactorrhea. This sign usually disappears within a few weeks but may persist until age 2.
Most males have physiologic gynecomastia at some time during adolescence, usually around age 14. This gynecomastia is usually asymmetrical and tender; it commonly resolves within 2 years and rarely persists beyond age 20.
PATIENT
COUNSELING:
Because gynecomastia may alter the patient's body image, provide emotional support. Reassure the patient that treatment can reduce gynecomastia.
Because gynecomastia may alter the patient's body image, provide emotional support. Reassure the patient that treatment can reduce gynecomastia.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)