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Gynecomastia

Última revisão: 18 Jun 2025
Última atualização: 15 Apr 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • palpable breast tissue
  • newborn age
  • pubertal age
  • older adult age
  • accidental medication exposure in children
  • substance use disorder
  • acne in adult males
  • obesity
  • breast pain
  • small or soft testicles
Detalhes completos

Outros fatores diagnósticos

  • erectile dysfunction or decreased libido
  • nutritional supplements
  • differences in sex development (DSD)
  • delayed secondary sex characteristics
  • precocious puberty
  • weight loss and malnutrition
  • signs or symptoms of hypothalamic or pituitary disease
  • signs or symptoms of liver failure (e.g., jaundice, ascites, spiders)
  • signs or symptoms of hyperthyroidism (e.g., heat intolerance, weight loss, goiter)
  • decreased body hair
  • painless or enlarging testicular mass
  • diminished strength or muscle atrophy
Detalhes completos

Fatores de risco

  • anabolic steroid usage
  • prostate cancer
  • hormone therapy for gender dysphoria
  • drugs that reduce testosterone synthesis
  • drugs that impair testosterone action
  • drugs that increase estrogen levels or stimulate estrogen receptors
  • occupational exposure to embalming fluid or oral contraceptives
  • contact with environmental phytoestrogens or phthalates
  • hyperthyroidism
  • renal failure
  • cirrhosis
  • drugs with complex or unknown mechanisms
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • serum TSH
  • serum creatinine
  • serum LFTs
Detalhes completos

Investigações a serem consideradas

  • serum total testosterone
  • serum LH
  • serum estradiol
  • serum sex hormone binding globulin (SHBG)
  • serum free testosterone
  • serum beta hCG
  • serum dehydroepiandrosterone-sulfate (DHEAS)
  • serum prolactin
  • mammogram
  • core biopsy of breast (if cancer suspected)
  • testicular ultrasound
  • abdominal CT/MRI (if adrenal adenoma or carcinoma suspected)
Detalhes completos

Algoritmo de tratamento

AGUDA

adults

pubertal idiopathic gynecomastia

infantile and prepubertal gynecomastia

Colaboradores

Autores

Glenn Braunstein, MD

Professor of Medicine

Cedars-Sinai Medical Center

Los Angeles

CA

Declarações

GB writes the chapters on Gynecomastia for UpToDate and Encyclopedia of Endocrine Diseases. GB is an author of references cited in this topic.

Agradecimentos

Dr Glenn Braunstein would like to gratefully acknowledge Dr Catherine B. Niewoehner, a previous contributor to this topic.

Revisores

Dennis Styne, MD

Professor of Pediatrics

Rumsey Chair of Pediatric Endocrinology

University of California

Sacramento

CA

Declarações

DS declares that he has no competing interests.

Harold Carlson, MD

Professor of Medicine and Head of Endocrinology

Stony Brook University

Stony Brook

NY

Declarações

HC is an author of a reference cited in this topic.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Kanakis GA, Nordkap L, Bang AK, et al. EAA clinical practice guidelines-gynecomastia evaluation and management. Andrology. 2019 Nov;7(6):778-93.Texto completo  Resumo

Bromley HL, Dave R, Lord N, et al. Gynaecomastia: when and why to refer to specialist care. Br J Gen Pract. 2021 Apr;71(705):185-8.Texto completo  Resumo

Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-44.Texto completo  Resumo

American College of Radiology. ACR appropriateness criteria: evaluation of the symptomatic male breast. 2018 [internet publication].Texto completo

Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018 Aug;200(2):423-32.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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