Gynecomastia: review

Gynecomastia is a common clinical condition consisting of a benign proliferation of male breast glandular tissue. It may be an incidental finding on routine examination or may present as an acute, unilateral or bilateral, painful tender mass beneath the areolar region. Most cases of gynecomastia have no known cause, especially in patients presenting in adolescence. An imbalance in the ratio of estrogen to androgen tissue levels is postulated as a major cause in the development of gynecomastia. Endocrine investigations may include the measurement of serum testosterone, estradiol, gonadotrophin, prolactin and thyroid function tests, but not all patients with gynecomastia require extensive laboratory analysis. There are three management considerations for gynecomastia: observation, drug therapy and surgery (mastectomy). Surgical removal is recommended: if a trial of medical therapy is unsuccessful; if no regression is present after 1 year observation; if the condition worsens; if psychosocial problems rise due to gynecomastia and in patients after completing pubertal period.