What are the guideline sources, guidelines and references for Gynecomastia ?
Guideline sources The following summarized guidelines for the evaluation and management of gynecomastia are prepared by our editorial team based on guidelines from the European Academy of Andrology (EAA 2019). 1 Guidelines 1. Diagnostic investigations General principles: consider presence of an underlying pathology in patients with gynecomastia of adulthood. Obtain a detailed investigation even if an apparent reason for gynecomastia of adulthood is identified, including the use of medication known to be associated with gynecomastia. B Show 2 more History taking: elicit a medical history including information on the onset and duration of gynecomastia, sexual development and function, and administration or abuse of substances associated with gynecomastia. B Physical examination: perform a physical examination to detect signs of under-virilization or systemic disease. A Show 2 more https://web.pathway.md/diseases/rec9X3ac2SNEXTP5I 1/3 6/24/23, 4:21 PM Gynecomastia Pathway Diagnostic imaging: Obtain testicular ultrasound to aid genitalia examination, as the detection of a testicular tumor by palpation has low sensitivity. B Obtain breast imaging where the clinical examination is equivocal. B Laboratory testing: Obtain the following laboratory investigations as part of the initial evaluation: testosterone estradiol sex hormone-binding globulin LH FSH TSH prolactin hCG AFP liver and renal function tests. B 2. Diagnostic procedures Core needle biopsy: perform core needle biopsy if the clinical picture is suspicious for a malignant lesion. B 3. Medical management Medical therapy: Offer testosterone only to male patients with proven testosterone deficiency. B Do not use selective estrogen receptor modulators, aromatase inhibitors, or non-aromatizable androgens in the treatment of gynecomastia in general. D 4. Surgical interventions Surgery: offer surgical treatment only for patients with long-lasting gynecomastia, which does not regress spontaneously or following medical therapy. The extent and type of surgery depend on the size of breast enlargement, and the amount of adipose tissue. B 5. Follow-up and surveillance Follow-up: offer watchful waiting after treatment of underlying pathology or discontinue the administration/abuse of substances associated with gynecomastia. B https://web.pathway.md/diseases/rec9X3ac2SNEXTP5I 2/3 6/24/23, 4:21 PM Gynecomastia Pathway References 1. Kanakis GA, Nordkap L, Bang AK et al. EAA clinical practice guidelines-gynecomastia evaluation and management. Andrology. 2019 Nov;7 6 778 793. Open https://web.pathway.md/diseases/rec9X3ac2SNEXTP5I 3/3