Gynecomastia

CLINICAL DIAGNOSTIC MANUAL

Gynecomastia is the enlargement of breast glandular tissue in men, which can occur in one or both breasts. This phenomen on is generally benign, but can cause concern due to its appearance and potential underlying causes.

Gynecomastia may result from an imbalance between estrogen and testosterone levels and can be unilateral or bilateral. It is common in newborns, adolescents, and older men due to hormonal changes at these life stages.

Pathology	Clinical Symptoms and Signs	Suspicion Diagnosis	Confirmation Diagnosis
Immature Testicles	Breast enlargement. Tenderness or pain.	Clinical history. Physical examination.	Hormonal analysis (low levels of testosterone).
Medications (digoxin and spironolactone)	Breast enlargement. Tenderness or pain.	Clinical history (use of medications).	Suspension of medication and observation. Hormonal analysis.
Alcohol Abuse	Breast enlargement. History of alcohol consumption.	Clinical history. Physical examination.	Altered liver function in blood tests.
Liver Cirrhosis	Breast enlargement. Signs of liver dysfunction (jaundice, ascites).	Clinical history. Physical examination.	Altered liver function tests. Abdominal ultrasound.
Testicular Tumours	Breast enlargement. Palpable testicular mass.	Clinical history. Physical examination (testicular mass).	Testicular ultrasound. Tumour markers (alpha-fetoprotein, hCG).
Hypogonadism	Breast enlargement. Reduction in secondary sexual characteristics.	Clinical history. Physical examination.	Hormonal analysis (low levels of testosterone, high levels of LH/FSH).
Bronchial Carcinoma	Breast enlargement. Respiratory symptoms (cough, haemoptysis).	Clinical history. Physical examination.	Thoracic imaging (X-ray, CT scan). Lung biopsy.
Klinefelter Syndrome	Breast enlargement. Small testicles, infertility.	Clinical history. Physical examination.	Chromosomal analysis (karyotype 47, XXY).
Obesity	Breast enlargement. Elevated body mass index.	Clinical history. Physical examination.	BMI evaluation. Hormonal levels (increased estrogens).