Gynecomastia differential diagnosis: Difference between revisions

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==Differentiating Gynecomastia from other Diseases==
==Differentiating Gynecomastia from other Diseases==
Gynecomastia can be differentiated from other pathologies by detailed history taking and physical examination.<ref name="pmid22534349">{{cite journal |vauthors=Dickson G |title=Gynecomastia |journal=Am Fam Physician |volume=85 |issue=7 |pages=716–22 |year=2012 |pmid=22534349 |doi= |url=}}</ref><ref name="pmid19546029">{{cite journal| author=Croes K, Baeyens W, Bruckers L, Den Hond E, Koppen G, Nelen V et al.| title=Hormone levels and sexual development in Flemish adolescents residing in areas differing in pollution pressure. | journal=Int J Hyg Environ Health | year= 2009 | volume= 212 | issue= 6 | pages= 612-25 | pmid=19546029 | doi=10.1016/j.ijheh.2009.05.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19546029  }} </ref><ref name="pmid20223338">{{cite journal| author=Laituri CA, Garey CL, Ostlie DJ, St Peter SD, Gittes GK, Snyder CL| title=Treatment of adolescent gynecomastia. | journal=J Pediatr Surg | year= 2010 | volume= 45 | issue= 3 | pages= 650-4 | pmid=20223338 | doi=10.1016/j.jpedsurg.2009.11.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20223338  }} </ref>
Gynecomastia can be differentiated from other pathologies by detailed history taking and physical examination.<ref name="pmid22534349">{{cite journal |vauthors=Dickson G |title=Gynecomastia |journal=Am Fam Physician |volume=85 |issue=7 |pages=716–22 |year=2012 |pmid=22534349 |doi= |url=}}</ref><ref name="pmid19546029">{{cite journal| author=Croes K, Baeyens W, Bruckers L, Den Hond E, Koppen G, Nelen V et al.| title=Hormone levels and sexual development in Flemish adolescents residing in areas differing in pollution pressure. | journal=Int J Hyg Environ Health | year= 2009 | volume= 212 | issue= 6 | pages= 612-25 | pmid=19546029 | doi=10.1016/j.ijheh.2009.05.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19546029  }} </ref><ref name="pmid20223338">{{cite journal| author=Laituri CA, Garey CL, Ostlie DJ, St Peter SD, Gittes GK, Snyder CL| title=Treatment of adolescent gynecomastia. | journal=J Pediatr Surg | year= 2010 | volume= 45 | issue= 3 | pages= 650-4 | pmid=20223338 | doi=10.1016/j.jpedsurg.2009.11.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20223338  }} </ref>
{| align="center" style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
{|
| valign="top" |
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|+
! rowspan="2" |Diseases
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! colspan="3" |Laboratory Findings
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
! colspan="4" |Physical Examination
!
! colspan="2" |History and Symptoms
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Estrogen-to-androgen ratio
!Cholesterol levels
!WBC count
!Tenderness
!Enlargement
!Nipple discharge
!Lymphadenopathy
!Other physical exam findings
!Age of onset
!Medication intake
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Gynecomastia]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Gynecomastia
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
* Round discrete [[mass]] felt under [[areola]] and usually bilateral.
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
{| class="wikitable"
|
* Round discrete [[mass]] felt under [[areola]] and usually bilateral.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Pseudogynecomastia
|}
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="background: #F5F5F5; padding: 5px;" |
* Increased [[adipose]] rather than [[glandular]] tissue on examination.
* Physiological gynecomastia is seen in newborns, adolescents and elderly
| style="background: #F5F5F5; padding: 5px;" |
* Pharmacological gynecomastia has hx of medication intake.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Lipoma]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Pseudo  gynecomastia
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
{| class="wikitable"
|
* Increased [[adipose]] rather than [[glandular]] tissue on examination.
|-
|}
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Breast Cancer
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-; mostly painless
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
|
* Usually painless mass
| style="background: #F5F5F5; padding: 5px;" |
* Middle age to elderly
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Lipoma
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
{| class="wikitable"
|
* Soft and mobile.
* Soft and mobile.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Breast cancer]]
|}
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Nipple]] discharge, [[Axillary|Axillary lymphadenopathy]], usually nonpainful [[mass]].
* Middle age to elderly
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Sebaceous cyst]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sebaceous cyst
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|
{| class="wikitable"
|
* Asymmetric enlargement and swelling feels closer to the skin.
* Asymmetric enlargement and swelling feels closer to the skin.
|-
|-
 
|}
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Mastitis]]
|Mastitis
| style="padding: 5px 5px; background: #F5F5F5;" |
|
*Systemic clinical features of infection.
|
| +
|Tender
| +/-
| +/-
| +/-
|
{| class="wikitable"
|
* Systemic clinical features of infection.
|}
|
|
|}
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 18:21, 28 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

Gynecomastia must be differentiated from other diseases that cause breast enlargement in men. These diseases include pseudo gynecomastia, breast cancer, breast abscess, and lipoma.

Differentiating Gynecomastia from other Diseases

Gynecomastia can be differentiated from other pathologies by detailed history taking and physical examination.[1][2][3]

Diseases Laboratory Findings Physical Examination History and Symptoms
Estrogen-to-androgen ratio Cholesterol levels WBC count Tenderness Enlargement Nipple discharge Lymphadenopathy Other physical exam findings Age of onset Medication intake
Gynecomastia ↑ +/- +
  • Round discrete mass felt under areola and usually bilateral.
  • Physiological gynecomastia is seen in newborns, adolescents and elderly
  • Pharmacological gynecomastia has hx of medication intake.
Pseudo gynecomastia +/- +
Breast Cancer +/-; mostly painless + + +
  • Usually painless mass
  • Middle age to elderly
Lipoma ↑ +/- +
  • Soft and mobile.
  • Middle age to elderly
Sebaceous cyst +
  • Asymmetric enlargement and swelling feels closer to the skin.
Mastitis + Tender +/- +/- +/-
  • Systemic clinical features of infection.

References

  1. ↑ Dickson G (2012). "Gynecomastia". Am Fam Physician. 85 (7): 716–22. PMID 22534349.
  2. ↑ Croes K, Baeyens W, Bruckers L, Den Hond E, Koppen G, Nelen V; et al. (2009). "Hormone levels and sexual development in Flemish adolescents residing in areas differing in pollution pressure". Int J Hyg Environ Health. 212 (6): 612–25. doi:10.1016/j.ijheh.2009.05.002. PMID 19546029.
  3. ↑ Laituri CA, Garey CL, Ostlie DJ, St Peter SD, Gittes GK, Snyder CL (2010). "Treatment of adolescent gynecomastia". J Pediatr Surg. 45 (3): 650–4. doi:10.1016/j.jpedsurg.2009.11.016. PMID 20223338.
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