Ddx Of Gynecomastia

Pseudogynecomastia = breast enlargement due to non-breast fatty tissue Gynecomastia = breast enlargement due to enlargement of breast tissue DD of pseudogynecomastia: - fat deposition - neoplasm

- neurofibromatosis - factitious

DD of Gynecomastia: 1- physiological: - neonate (due to ingestion of maternal estrogen) - puberty - old age 2A-

pathological: increase estrogen: estrogen-secreting testicular tumor (leydig cell tumor) estrogen-secreting adrenal tumor exogenous estrogen use (as treatment of prostatic carcinoma) alcoholism (damage leydig cell) obesity - liver disease hereditary - thyrotoxicosis

B- decrease androgen: - hCG-producing tumors (testicular tumor, bronchial carcinoma, lung cancer, carcinoid tumors of lung + GIT) - endocrinopathies (acromegaly, cushing's syndrome, true hermaphroditism, klinefelter's syndrome, adrenal agenesis) - testicular failure (orchitis, castration, trauma) C- others: chronic illness, starvation / refeeding, renal failure, local trauma, pituitary tumor (prolactinoma), intrathoracic malignancy, paraplegia, erthroderma, idiopathic D- drugs: - Estrogen - cimetidine - griseofulvin - phenytoin - isoniazid - histamine antagonist

- spironolactone - digitalis - amphetamines - tricyclic antidepressants - ca channel antagonist

Done by Dr.Wala'a Gholam [email protected]

www.medkaau.com/vb

Sources Churchill’s pocketbook of differential diagnosis -

Harrison’s manual of medicine

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Bedside medicine without tears by SN Chugh

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Clinical examination by Nicholas J Talley

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- diazepam - cytotoxic drugs - methyldopa - testosterone - marijuana

Self assessment Questions in internal medicine by dr. Daad and dr. Maimoona Browse’s introduction to the symptoms and signs of surgical diseases

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The mont reid surgical hand book