Gynecomastia in a Hospitalized Male Population

Niewoehner, Catherine; Nuttall, Frank Q.

doi:10.1016/s0022-5347(17)49186-5

Cited by 22 publications

(44 citation statements)

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“…There were only five malignancies in our series, representing no more than 0.89% of the examinations. This reflects the high prevalence of gynecomastia and the low prevalence of carcinoma of the breast in males . The imaging performed in our institution had a low yield; many of the examinations were performed to confirm benign clinical diagnoses and did not add significant information to the clinical diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Overuse of Imaging the Male Breast-Findings in 557 Patients

Lapid

Siebenga

Zonderland³

2015

Breast J

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Gynecomastia is the most common abnormality of the male breast. However, breast cancer may occur, albeit with a significantly lower incidence than in females. Imaging is often used as part of the diagnosis. The aim of this study was to assess the utilization and outcome of imaging with mammography or ultrasound of the male breast in a university hospital's department of radiology. A retrospective study assessing the imaging of the male breast in 557 patients over a 10-year period. Referral was done mainly by general surgeons and general practitioners. The most common indication was enlargement of the breast, described as gynecomastia or swelling in 74% of patients, followed by pain in 24% and "lumps" in 10%. The modalities used were mammography in 65%, ultrasound in 51% and both in 26%. Most examinations, 519, were BI-RADS 1 or 2, and 38 were BI-RADS 3 or higher. Altogether 160 patients had additional fine-needle aspiration or biopsy. Malignancies were diagnosed in five patients (0.89%). Imaging had a sensitivity of 80% and a specificity of 99%. The positive predictive value was 44% and the negative predictive value 99.8%. Malignancies are rare in the male breast. The probability of finding cancer when performing imaging of clinically benign findings in the male breast is negligible. Imaging is not warranted unless there are suspicious abnormalities. Routine imaging of gynecomastia should be discouraged.

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Section: Discussionmentioning

confidence: 99%

“…The most common anomalous finding in the male breast is gynecomastia—excessive enlargement of the breast, seen in up to 64% of adolescents and up to 72% of hospitalized patients . The etiology is attributed to hormonal imbalance which in most cases is idiopathic, but may also be caused by systemic diseases and medicine use .…”

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confidence: 99%

Overuse of Imaging the Male Breast-Findings in 557 Patients

Lapid

Siebenga

Zonderland³

2015

Breast J

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“…Men with a body mass index of 25 kg/m 2 or more are far more likely to develop gynecomastia or pseudo gynecomastia, with a reported prevalence as high as 80% (11).…”

Section: Prevalencementioning

confidence: 99%

Overview of Gynecomastia in the Modern Era and the Leeds Gynaecomastia Investigation Algorithm

et al. 2011

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Gynecomastia is a benign enlargement of male breast glandular tissue. At least a third of males are affected at some time during their lifetime. Idiopathic causes exceed other etiologies and relate to an imbalance in the ratio of estrogen to androgen tissue levels or end-organ responsiveness to these hormones. Assessment must include a thorough history and clinical examination, specific blood investigations and usually tissue sampling and/or breast imaging. Management consists of a combination of measures that may include simple reassurance, pharmacological manipulation, medical treatment or surgery. Hormone therapy may help to abort the acute proliferative phase of gynecomastia with a 30% response rate but should not be considered in chronic established cases. Surgical treatment may comprise simple liposuction for a predominant fatty component or direct excision when glandular tissue is predominant. The main aim is to control the patient's symptoms and to exclude other etiological factors.

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“…The reported prevalence of GM in adult men varies widely, partly because of different diagnostic criteria applied and partly because of selection of study populations; it has been stated to be as high as 36–57%, especially among the elderly (Nuttall, ; Niewoehner & Nuttal, ; Georgiadis et al ., ). The corresponding figure at autopsy series is 40–55% (Williams, ).…”

Section: Epidemiologymentioning

confidence: 99%

EAA clinical practice guidelines—gynecomastia evaluation and management

et al. 2019

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Background: Gynecomastia (GM) is a benign proliferation of the glandular tissue of the breast in men. It is a frequent condition with a reported prevalence of 32-65%, depending on the age and the criteria used for definition. GM of infancy and puberty are common, benign conditions resolving spontaneously in the majority of cases. GM of adulthood is more prevalent among the elderly and proper investigation may reveal an underlying pathology in 45-50% of cases. Objectives: The aim was to provide clinical practice guidelines for the evaluation and management of GM. Materials and methods: A literature search of articles in English for the term 'gynecomastia' was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results: A set of five statements and fifteen clinical recommendations was formulated. Conclusions: The purpose of GM assessment should be the detection of underlying pathological conditions, reversible causes (administration/abuse of aggravating substances), and the discrimination from other breast lumps, particularly breast cancer. Assessment should comprise a thorough medical history and physical examination of the breast and genitalia (including testicular ultrasound). A set of laboratory investigations may integrate the evaluation: testosterone (T), estradiol (E2), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicular stimulating hormone (FSH), thyroid stimulating hormone (TSH), prolactin, human chorionic gonadotropin (hCG), alpha-fetal protein (AFP), liver and renal function tests. Breast imaging may be used whenever the clinical examination is equivocal. In suspicious lesions, core needle biopsy should be sought directly instead. Watchful waiting is recommended after treatment of underlying pathology or discontinuation of substances associated with GM. T treatment should be offered to men with proven T deficiency. The use of selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs) and non-aromatizable androgens is not justified in general. Surgical treatment is the therapy of choice for patients with long-lasting GM.

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Gynecomastia in a Hospitalized Male Population

Cited by 22 publications

References 0 publications

Overuse of Imaging the Male Breast-Findings in 557 Patients

Overuse of Imaging the Male Breast-Findings in 557 Patients

Overview of Gynecomastia in the Modern Era and the Leeds Gynaecomastia Investigation Algorithm

EAA clinical practice guidelines—gynecomastia evaluation and management

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