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Am Fam Physician. 1999;59(8):2346-2347

Gynecomastia occurs in 40 to 65 percent of men but is asymptomatic in almost all cases. Patients may present for medical care because of tenderness in the breast mass, or they may be concerned about their body image. Since the role of endocrine testing in gynecomastia is controversial, Bowers and colleagues made a retrospective study to find the most cost-effective approach to patients with gynecomastia.

The medical records of all patients with gynecomastia presenting to an academic center between 1992 and 1997 were analyzed. The average age of the 87 men was 47 years (range 18 to 90 years); 73 had unilateral breast enlargement. Initial assessment identified hepatic or renal disease in 14 patients, medication-induced gynecomastia in 18 patients and hyperthyroidism in two patients. The remaining 53 patients (61 percent) were considered idiopathic cases.

Eight patients with idiopathic disease had fine needle aspiration followed by excision of the breast mass. All of these lesions were benign. The remaining 45 patients underwent some form of endocrine evaluation. One patient was found to have bilateral gynecomastia due to an occult Leydig cell testicular tumor. Endocrine testing was normal in the remaining patients, and all underwent simple excision.

The authors conclude that routine evaluation of idiopathic gynecomastia is rarely productive. Breast cancer should be apparent on initial physical examination followed, if necessary, by fine needle aspiration. If adrenal or testicular lesions are suspected of causing gynecomastia, ultrasound examination is less expensive and more accurate than endocrine evaluation.

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