Child With Suspected Gynecomastia

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

 

Suggested References and Additional Reading:

• Question From the Clinician: Adolescent Gynecomastia. Peds in Review. 2003 Sep; 24(9): 317-319. doi: 10.1542/pir.24-9-317
• Nordt CA, DiVasta AD. Gynecomastia in adolescents. Curr Opin Pediatr.2008 Aug;20(4):375-82. doi:10.1097/MOP.0b013e328306a07c.