Evaluation of Gynecomastia - Flowchart
Evaluation of Gynecomastia - Flowchart
«Flowchart»

Breast Enlargement

Breast Enlargement

Breast Enlargement

Breast Enlargement

True glandular enlargement

True glandular enlargement

True glandular enlargement

Increased adipose tissue

Increased adipose tissue

Increased adipose tissue

Follow-up with serial examinations

Follow-up with serial examinations

Follow-up with serial examinations

Mammography and/or biopsy to exclude malignancy

Mammography and/or biopsy to exclude malignancy

Mammography and/or biopsy to exclude malignancy

Androgen deficiency syndrome

Androgen deficiency syndrome

Androgen deficiency syndrome

Exclude hCG secreting tumors

Exclude hCG secreting tumors

Exclude hCG secreting tumors

Increased aromatization of androgen to estrogen (obesity, feminizing adrenal tumors, Sertoli cell tumors, inherited dysregulation of aromatase)

Increased aromatization of androgen to estrogen (obesity, feminizing adrenal tumors, Sertoli cell tumors, inherited dysregulation of aromatase)

Increased aromatization of androgen to estrogen (obesity, feminizing adrenal tumors, Sertoli cell tumors, inherited dysregulation of aromatase)

End

End

End

Clinical evidence of androgen deficiency
Breast tenderness
Very small testes
Glandular tissue >4 cm in diameter
Absence of causative drugs or liver disease

Clinical evidence of androgen deficiency
Breast tenderness
Very small testes
Glandular tissue >4 cm in diameter
Absence of causative drugs or liver disease





Clinical

Onset in neonatal or peripubertal period
Causative drugs
Known liver disease
Size <4 cm

Onset in neonatal or peripubertal period
Causative drugs
Known liver disease
Size <4 cm




Onset

Breast mass hard or fixed to the underlying tissue
Recent onset and rapid growth

Breast mass hard or fixed to the underlying tissue
Recent onset and rapid growth


Breast

E2, 17-estradiol; FSH, follicle-stimulating hormone; hCG, human chorionic gonadotropin ; LH, luteinizing hormone; T, testosterone.

E2, 17-estradiol; FSH, follicle-stimulating hormone; hCG, human chorionic gonadotropin ; LH, luteinizing hormone; T, testosterone.

E2, 17-estradiol; FSH, follicle-stimulating hormone; hCG, human chorionic gonadotropin ; LH, luteinizing hormone; T, testosterone.

Serum T, LH, FSH, estradiol, and hCG

Serum T, LH, FSH, estradiol, and hCG

Serum T, LH, FSH, estradiol, and hCG

Low T, high E2/T ratio

Low T, high E2/T ratio

2 Low T

Increased hCG

Increased hCG

Increased hCG

Increased E2, normal T, altered E2/T ratio

Increased E2, normal T, altered E2/T ratio

2 2 Increased E(2)