Child With Suspected Gynecomastia

Referral Guidelines are peer reviewed guidelines developed to assist referring providers in their approach to a patient presenting with common signs or symptoms suggestive of an endocrine condition, and when to refer to Pediatric Endocrinology.

Suggestive history and physical findings:

Labs and/or radiology studies can include:

Blood tests:
• Consider evaluation in prepubertal males or if pubertal males with significant breast tissue (after consultation with Pediatric Endocrinologist)
o LFTs
o LH, FSH*
o Testosterone*
o Estradiol*
o DHEA-S
o TSH, Free T4
o hCG
o Prolactin
o Karyotype

Radiologic studies:
• Testicular ultrasound if testicular mass or elevated hCG

*Pubertal laboratory tests should be obtained in the early AM using sensitive pediatric assays only

When to refer:

Items useful for consultation:

Patient Education Materials:

Differential diagnosis of gynecomastia:

Pubertal gynecomastia
Pseudogynecomastia due to obesity/lipomastia
Hypogonadism
Hyperthyroidism
Exogenous exposures to lavender, tea-tree oil
Medication Induced: Antipsychotics, Anabolic steroids, Alcohol or drugs of abuse including: marijuana, heroin, amphetamines
Pathologic causes: hCG secreting tumors, testosterone or estrogen secreting tumors (Leydig cell tumor, adrenal tumor), liver disease (chronic)
Breast masses: benign tumors (lipomas, neurofibromas, dermoid cysts), rarely carcinomas

Additional information:

Benign, pubertal gynecomastia is the most common cause of gynecomastia and occurs in up to 2/3 of normal pubertal boys, with the majority of pubertal gynecomastia self-resolving by completion of puberty.

o Laboratory/radiologic evaluation is generally not needed in boys with suspected pubertal gynecomastia unless there is significant or rapidly changing breast development.

o Boys with suspected pubertal gynecomastia should be monitored for rapid progression of breast development.

Gynecomastia results due to relative imbalance between testosterone and estradiol levels, transient estradiol excess or increased sensitivity of breast tissue to estrogen.
Gynecomastia can be commonly associated with Klinefelter syndrome.
No good treatment options exist, regardless of cause. Once growth and puberty is complete, referral for cosmetic surgery may be considered.

Treatment:

Suggested References and Additional Reading:

Authors/date revised:

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