Breast

Question 1

Gynaecomastia
To complete my examinations

Answer 1

To complete my examination:
• Complete abdominal examination to detect liver enlargement (liver cirrhosis)
• Testicular examination to rule out testicular enlargement (tumor), or atrophy
• External genitalia examination to rule out hypogonadism
• Check thyroid status to rule out hyperthyroidism
• Check signs of liver failure
• Check signs of renal failure
• Visual field examination to rule out prolactinoma
• Chest examination to rule out bronchial carcinoma

Question 2

Causes of bilateral gynecomastia?

Laboratory studies?

Imaging studies?

Treatment?

Answer 2

• Liver cirrhosis due to alcoholism (the main probable cause in this patient) as a result of failure of the liver to metabolize estrogens

• Bronchial carcinoma

• Pituitary tumors (prolactinoma)

• Hyperthyroidism

• Testicular tumors

• Renal failure

• Hypogonadism

• Drug related

• Senility

Drug-induced gynaecomastia caused by cimetidine.

• A serum chemistry panel may be helpful in evaluating for renal or liver disease.
• Free or total testosterone, luteinizing hormone (LH), estradiol, and dehydroepiandrosterone sulfate levels are used to evaluate a patient with possible feminization syndrome.
• thyroid-stimulating hormone (TSH) and free thyroxine levels if hyperthyroidism is suspected.
• Serum prolactin levels, if pituitary tumors were suspected
• Testicular tumor markers

• Mammogram if 1 or more features of breast cancer are apparent upon clinical examination.
• This can be followed by fine-needle aspiration or breast biopsy, as the case merits.
• Testicular ultrasonogram if the serum estradiol level is elevated and the clinical examination findings suggest the possibility of a testicular neoplasm.
• Abdominal ultrasound to detect liver cirrhosis
• Chest x ray to rule out chest malignancies

• Treatment of the underlying cause
• Surgical:
o Reduction mammoplasty o Mastectomy with preservation of the areola and nipple can be performed