Case history
Case history #1
A 58-year-old man presents for follow-up after hypertension was noted at a health fair. He is taking an ACE inhibitor. Heartburn is controlled by over-the-counter famotidine. He has some difficulty achieving an erection. Body mass index is 31 kg/m². Body habitus and body hair distribution are normal except for central obesity. He has 3 cm of firm breast tissue under each nipple without axillary adenopathy. Testes are slightly soft, and testicular volume is normal at 20 cm³. [Figure caption and citation for the preceding image starts]: Patient with gynecomastiaFrom the collection of Catherine B. Niewoehner, MD [Citation ends].
Case history #2
A 28-year-old man presents with increasing acne and painful, enlarged breasts. Eighteen months ago he started a body-building regimen including intense exercise and a "superman" androgen supplement. Physical examination reveals a body mass index of 27 kg/m²; pronounced musculature; tender, firm breast tissue 5 cm on the right and 7 cm on the left; and small (6 cm³), soft testicles bilaterally.
Other presentations
Boys often present with gynecomastia at the time of puberty. This may or may not be painful but often causes marked psychological distress. Men with prostate cancer treated with drugs to suppress testosterone production or testosterone action often develop gynecomastia and breast pain. Gynecomastia may less commonly be a sign of primary testicular failure, pituitary insufficiency, or, rarely, feminizing tumors.
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