Evaluation of an adult patient with breast enlargement
Evaluation of an adult patient with breast enlargement
Algorithm for interpretation of serum hormone levels and suggestions for further evaluation of patients with gynecomastia.
Neg H&P: Negative history and physical exam; T: testosterone; LH: luteinizing hormone; E2: estradiol; hCG: human chorionic gonadotropin; NI: normal; TSH: thyroid-stimulating hormone; T4: thyroxine; CT: computed tomography; MRI: magnetic resonance imaging; SHBG: sex hormone-binding globulin. * Negative history and physical exam (ie, not undergoing pubertal transition; no history of medications associated with gynecomastia; no evidence of hyperthyroidism, adrenal or testicular masses, or liver or kidney disease). ¶ In some patients with early primary hypogonadism, the T level may be in the lower half of the normal range. Δ In hyperthyroidism, SHBG is elevated, which leads to an increase in total T. In addition, free T can be lowered slightly, leading to higher LH levels that are not totally compensated for.
