小结
定义
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
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
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
诊断性检查
首要检查
- serum TSH
- serum creatinine
- serum LFTs
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)
治疗流程
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 writes the chapters on Gynecomastia for UpToDate and Encyclopedia of Endocrine Diseases. 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Kanakis GA, Nordkap L, Bang AK, et al. EAA clinical practice guidelines-gynecomastia evaluation and management. Andrology. 2019 Nov;7(6):778-93.全文 摘要
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.全文 摘要
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.全文 摘要
American College of Radiology. ACR appropriateness criteria: evaluation of the symptomatic male breast. 2018 [internet publication].全文
Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018 Aug;200(2):423-32.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Breast cancer
- Benign breast masses
- Pseudogynecomastia
更多 鉴别诊断指南
- EAU guidelines on sexual and reproductive health
- ACR appropriateness criteria: evaluation of nipple discharge
更多 指南患者教育信息
Obesity - drugs and surgery
更多 患者教育信息登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明