Some Causes of Gynecomastia
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
History of chronic kidney disease | Serum electrolytes, BUN, and creatinine Urinalysis Possibly urine culture and urinary levels of sodium, potassium, and creatinine | |
Often history of liver disease, alcohol use, or both Ascites, spider angiomas, dilated abdominal veins | Routine laboratory testing Sometimes liver biopsy | |
Drugs (see table Common Drug Causes of Gynecomastia) | History of use | Trial of stopping the drug |
Feminizing adrenocortical tumor | Palpable mass, testicular atrophy | Imaging (MRI or CT) |
Tremor, heat intolerance, diarrhea, tachycardia, weight loss, goiter, exophthalmos | Thyroid function tests | |
Prepubertal onset: Underdeveloped secondary sexual characteristics Postpubertal onset: Decreased libido, erectile dysfunction, mood changes, decreased muscle and increased fat mass, osteopenia, testicular atrophy, mild cognitive changes | Serum FSH, LH, and testosterone levels (see Diagnosis) | |
Paraneoplastic ectopic production of hCG | Possibly signs of primary tumor or symptoms and signs of hypogonadism | Evaluation for suspected primary tumor |
Testicular mass Possibly symptoms and signs of hypogonadism | Scrotal ultrasonography | |
Feeding after undernutrition | Muscle and fat wasting, hair loss, skin changes, frequent infections, fatigue, signs of vitamin deficiencies (eg, osteopenia) | Clinical evaluation Selective laboratory testing |
Idiopathic gynecomastia | No abnormal findings other than gynecomastia, no symptoms, no apparent cause | Repeat clinical evaluation in 6 months Possibly serum testosterone level |