Деякі причини гінекомастії

Chronic kidney disease

History of chronic kidney disease

Serum electrolytes, BUN, and creatinine

Urinalysis

Possibly urine culture and urinary levels of sodium, potassium, and creatinine

Cirrhosis

Often history of liver disease, alcohol use, or both

Ascites, spider angiomas, dilated abdominal veins

Routine laboratory testing

Sometimes liver biopsy

Drugs (see table Common Drug Causes of Gynecomastia)

History of use

Trial of stopping the drug

Feminizing adrenocortical tumor

Palpable mass, testicular atrophy

Imaging (MRI or CT)

Hyperthyroidism

Tremor, heat intolerance, diarrhea, tachycardia, weight loss, goiter, exophthalmos

Thyroid function tests

Hypogonadism

Prepubertal onset: Underdeveloped secondary sexual characteristics

Postpubertal onset: Decreased libido, erectile dysfunction, mood changes, decreased muscle and increased fat mass, osteopenia, testicular atrophy, mild cognitive changes

Serum FSH, LH, and testosterone levels (see Diagnosis)

Paraneoplastic ectopic production of hCG

Possibly signs of primary tumor or symptoms and signs of hypogonadism

Evaluation for suspected primary tumor

Testicular tumors

Testicular mass

Possibly symptoms and signs of hypogonadism

Scrotal ultrasonography

Feeding after undernutrition

Muscle and fat wasting, hair loss, skin changes, frequent infections, fatigue, signs of vitamin deficiencies (eg, osteopenia)

Clinical evaluation

Selective laboratory testing

Idiopathic gynecomastia

No abnormal findings other than gynecomastia, no symptoms, no apparent cause

Repeat clinical evaluation in 6 months

Possibly serum testosterone level