Gynaecomastia
Approach
- Expose as for chest examination
- Position to 45'
- Inspect
- Presence of uni / bi-lateral breast swellings
- Palpate
- Percuss
- Auscultate
Completion
- Look for causes of gynaecomastia
- Physiological: puberty
- Drugs: marihuana, amphetamines, cimetidine, ranitidine, digoxin, ACEi, metronidazole, isoniazid
- Endocrine: hypo/hyperthyroidism, hypogonadism, acromegaly, Klinefelter's syndrome
- Malignancy: testicular tumours, lymphoma
- Liver disease: alcholic cirrhosis
- Examine external genitalia
- Clinical signs of thyroid function
- Signs of liver disease
Investigations
- Determine the cause!
- AFP, bHCG - rasied in testicular tumour
- LH/FSH/testosterone levels
- Thyroid function tests
