EAA clinical practice guidelines—gynecomastia evaluation and management

• DOI: 10.1111/andr.12636
• Publication Date: 2019-05-17T04:53:43Z
• Authors: G. A. Kanakis; L. Nordkap; A. K. Bang; A. E. Calogero; G. Bártfai; G. Corona; G. Forti; J. Toppari; D. G. Goulis; N. Jørgensen
• Keywords: Gynecomastia; Breast enlargement; Watchful waiting

Gynecomastia (GM) is a benign proliferation of the glandular tissue breast in men. It frequent condition with reported prevalence 32-65%, depending on age and criteria used for definition. GM infancy puberty are common, conditions resolving spontaneously majority cases. adulthood more prevalent among elderly proper investigation may reveal an underlying pathology 45-50% cases.The aim was to provide clinical practice guidelines evaluation management GM.A literature search articles English term 'gynecomastia' conducted. Evidence-based recommendations were developed using Grading Recommendations, Assessment, Development, Evaluation (GRADE) system.A set five statements fifteen formulated.The purpose assessment should be detection pathological conditions, reversible causes (administration/abuse aggravating substances), discrimination from other lumps, particularly cancer. Assessment comprise thorough medical history physical examination genitalia (including testicular ultrasound). A laboratory investigations integrate evaluation: testosterone (T), estradiol (E2), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicular stimulating (FSH), thyroid (TSH), prolactin, human chorionic gonadotropin (hCG), alpha-fetal protein (AFP), liver renal function tests. Breast imaging whenever equivocal. In suspicious lesions, core needle biopsy sought directly instead. Watchful waiting recommended after treatment or discontinuation substances associated GM. T offered men proven deficiency. The use selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs) non-aromatizable androgens not justified general. Surgical therapy choice patients long-lasting GM.S1. males. S2. common that usually resolves spontaneously, typically within first year life. S3. condition, affecting approximately 50% mid-pubertal boys; than 90% cases, it 24 months. S4. increases increasing age; S5. Male cancer rare; considered premalignant condition. following divided into 'strong', denoted by number 1 terminology 'we recommend', 'weak' 2 phrase suggest'. grading quality evidence as follows: ⊕○○○ very low-quality evidence; ⊕⊕○○ low quality; ⊕⊕⊕○ moderate ⊕⊕⊕⊕ high quality. R1. presence adulthood. We recommend identification apparent reason adulthood, including medication known GM, preclude detailed (1 ⊕⊕⊕○). R2. suggest initial screening rule out lipomastia, obvious cancer, might performed general practitioner another non-specialist (2 ⊕○○○). R3. those cases where diagnostic workup warranted, specialist R4. include information onset duration sexual development function, administration abuse R5. detect signs under-virilization systemic disease ⊕⊕⊕⊕). R6. confirm palpable discriminate lipomastia (pseudo-gynecomastia) suspicion malignant tumor R7. atrophy R8. aided ultrasound, palpation has sensitivity ⊕⊕○○). R9. evaluations T, E2 , SHBG, LH, FSH, TSH, hCG, AFP, tests R10. offer assistance, equivocal R11. that, if picture lesion, R12. watchful administration/abuse R13. only deficiency R14. do (AIs), R15. surgical which does regress therapy. extent type surgery depend size enlargement, amount adipose