Endocrinology Question 40 Instructor

List five causes of gynecomastia and how you would investigate for them.

Diagnosis Investigation
Ideopathic, obesity, adolescent Diagnosis of exclusion
Primary hypogonadism Low testosterone
High LH, FSH
XYY karyotype
Liver cirrhosis AST
Testicular germ cell cancer b-HCG
Drugs: spironolactone, digitalis, cimetidine History
Hyperthyroidism sTSH
Free T4
Free T3
Rare: adrenal estrogen-producing tumour Estradiol level

Other rare causes:

  • Androgen insensitivity syndrome (partial)
  • Ectopic HCG
  • Excess aromatization
  • True hermaphrodite

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