Gynecomastia

This 15-year-old boy presented with a 3-year history of gradual, bilateral breast enlargement. He was otherwise healthy and showed normal pubertal development.

Most cases of bilateral gynecomastia are idiopathic, writes Dr William B. Wadlington of Hermitage, Tenn, but an increased estrogen-to-androgen ratio is the most common pathologic cause. Estrogen levels commonly are elevated in patients with tumors of the pituitary gland or the adrenal glands, in those who have disorders that cause excessive aromatase activity, and in persons with liver disease. A decrease in testosterone levels may be seen in patients who have Klinefelter's syndrome (male karyotype 47,XXY) or a 46,XX male phenotype, in those with defective testosterone synthesis, and in persons with primary Leydig cell dysfunction.

This adolescent chose to have breast reduction surgery because of the cosmetic and functional impairments of gynecomastia.