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Gynecomastia

Última revisão: 13 Feb 2025
Última atualização: 10 Oct 2024

Resumo

Definição

病史和体格检查

关键诊断因素

  • 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
完整详情

其他诊断因素

  • 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
完整详情

危险因素

  • 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
完整详情

诊断性检查

首要检查

  • serum TSH
  • serum creatinine
  • serum LFTs
完整详情

需考虑的检查

  • 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)
完整详情

治疗流程

急症处理

adults

pubertal idiopathic gynecomastia

infantile and prepubertal gynecomastia

撰稿人

作者

Glenn Braunstein, MD

Professor of Medicine

Cedars-Sinai Medical Center

Los Angeles

CA

利益声明

GB was a paid expert witness for Johnson and Johnson to help defend them against suits alleging that Risperdal® (risperidone) causes gynecomastia, but has not been active in this suit for over a year and a half. GB writes extensively on this topic and is the major author for gynecomastia in UpToDate. GB is currently revising his chapter on gynecomastia for the Encyclopedia of Endocrine Diseases, Third Edition. GB is an author of references cited in this topic.

鸣谢

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

同行评议者

Dennis Styne, MD

Professor of Pediatrics

Rumsey Chair of Pediatric Endocrinology

University of California

Sacramento

CA

利益声明

DS declares that he has no competing interests.

Harold Carlson, MD

Professor of Medicine and Head of Endocrinology

Stony Brook University

Stony Brook

NY

利益声明

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

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