Gynaecomastia in men is a distressing condition that can present a diagnostic challenge. This article reviews the causes of gynaecomastia in men and discusses the management options available.
Clinton is a 76-year-old Caucasian man with a history of hyperaldosteronism. He has come to see you, his GP, because of tenderness in both of his nipples. Clinton’s other past medical history includes type 2 diabetes mellitus, obstructive sleep apnoea, gastro-oesophageal reflux disease, fatty liver disease and obesity. Three months ago, he was diagnosed with bilateral idiopathic primary hyperaldosteronism confirmed on a saline suppression test and adrenal vein sampling. He was commenced on spironolactone to manage his hypertension and hypokalaemia.
Clinton is taking metformin, omeprazole, perindopril, metoprolol, aspirin and rosuvastatin in addition to spironolactone. He has no allergies. He is a lifelong nonsmoker and drinks three standard drinks per night, five nights a week. On examination, Clinton’s blood pressure is 130/80mmHg and pulse rate is 90 beats per minute. His weight is 115kg, height 1.68m and body mass index (BMI) 40.7kg/m2. Breast examination reveals symmetrical breast fullness bilaterally. There is no redness or skin changes on visual examination. On palpation, there are no breast masses or lymphadenopathy. Behind each areola there is a palpable firm and tender, mobile, 1cm diameter, rubbery-feeling ridge.