Endocrine Abstracts

Introduction: Gynaecomastia, a benign enlargement of glandular breast tissue in males, may be associated with anxiety, depression and reduced self-esteem.

Aims: To assess current practice in management and treatment outcomes in the management of gynaecomastia with a view to improving quality of service and rationalising investigations and referral pathway.

Methods: A health informatics search identified 42 patients with documented gynaecomastia reviewed in general endocrinology outpatient clinics between 2013-and 2018. 2 had incomplete data and were excluded from further analysis. A structured proforma was completed for each patient. Data were collected on patient demographics, clinical features on presentation, investigations, diagnosis, treatment and outcomes. Baseline investigations included liver, thyroid and kidney function, serum testosterone, oestradiol, LH, FSH, prolactin and beta-hCG.

Results: Underlying causes of gynaecomastia were divided into 3 categories: idiopathic (n=18, 45%), medical (n=4, 10%) and endocrine (n=18, 45%). Mean age at presentation was 40.4 years, (+/−18.9). 50% of patients had a BMI >25. Causes included primary (n=5, 12.5%) and secondary hypogonadism (n=3, 7.5%), hyperprolactinaemia (n=2, 5%), Klinefelter’s (n=6, 15%), anabolic steroids (n=1, 2.5%), alcohol excess (n=1, 2.5%) and spironolactone (n=1, 2.5%). Management of underlying cause and weight were offered. 7/40 (17.5%) had a documented improvement in symptoms. Of these all had endocrine diagnoses. 38% with endocrine conditions improved symptomatically. 15/18 with idiopathic gynaecomastia were referred for surgical opinion on the NHS and all were discharged without surgical treatment.

Conclusions: In the majority of cases a hormonal cause for gynaecomastia was not identified. Screening for these conditions at referral may help utilise resources more effectively. Symptomatic improvements may be seen in those with endocrine conditions. There remains a large unmet need for effective treatment options for resistant cases.