Gyn ecom ast ia Diagn osis an d M an agem en t

ABBREVIATIONS:
Enlargement of IGF-1: insulin-like growth factor-1
male breast SHBG: sex-hormone binding globulin

Is No further
there evaluation needed
palpable glandular No
Reassure, or
breast tissue?
consider plastic
surgery

Yes

Perform
testicular
ultrasound

Is there
breast tissue
Is there a that is hard,
No
tumor? nontender, or joining
underlying
Yes
structure?

Refer for Yes

urologic
evaluation No
Perform biopsy

Malignant Benign

Recommend Is No further
surgery Is age of phenotype evaluation needed
onset No or testicular size No
Reassure, or
>18 years? abnormal?
consider plastic
surgery
Yes
Yes

Is
there Perform detailed medical history
No
anabolic steroid
use? Obtain:
- Alanine transaminase
Yes - Alkaline phosphatase
- Androstenedione
Treat and - Creatinine
remove cause - Estradiol
- Estrone
- Luteinizing hormone
- Prolactin
- SHBG
- Testosterone
- Thyroid-stimulating hormone
- Triiodothyronine
Consider obtaining
genetic/IGF-1/chromosomal

No further
evaluation needed
Is a cause
No
detected? Reassure, or
consider plastic
Yes surgery

Treat and/or
remove cause

REFERENCES: Andrology. 2019 Nov;7(6):778?93 - Eur JEndocrinol. 2017 May;176(5):555?566

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