Photo Quiz

Severe Male Breast Enlargement

 

Am Fam Physician. 2017 May 1;95(9):583-584.

A 13-year-old boy presented with increased breast size and darkening of the areola, which began at 11 years of age. He had occasional soreness in the breast area but no nipple discharge. His medical history included asthma, allergic rhinitis, obesity, and dyslipidemia treated with pravastatin (Pravachol). He was not using any other medications or illicit drugs.

Physical examination revealed grade 3 gynecomastia with ptotic, or sagging, breasts (Figures 1 and 2). The nipples fell below the inframammary crease. The breasts appeared to consist of fat and glandular tissues with enlarged and darkened areolas. No palpable masses were noted.


Figure 1


Figure 2

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Medication or illicit drug use.

B. Physiologic gynecomastia.

C. Primary hypogonadism.

D. Pseudogynecomastia.

E. Te

Address correspondence to Chinwe E. Ukaonu, MD, at cukaonu@phoebehealth.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Dickson G. Gynecomastia. Am Fam Physician. 2012;85(7):716–722....

2. Sansone A, Romanelli F, Sansone M, Lenzi A, Di Luigi L. Gynecomastia and hormones. Endocrine. 2017;55(1):37–44.

3. Dantanarayana N, Connolly J. An interesting case of gynaecomastia. Aust Fam Physician. 2016;45(1):53–55.

4. Chau A, Jafarian N, Rosa M. Male breast: clinical and imaging evaluations of benign and malignant entities with histologic correlation. Am J Med. 2016;129(8):776–791.

5. Swerdloff R, Ng JC. Gynecomastia: etiology, diagnosis, and treatment. http://www.endotext.org [free registration required]. Accessed September 20, 2016.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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