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  #1  
Old 06-19-2012
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Post Tricky but nice question...

A 13-year-old boy has a tender subareolar mass in the left breast. Physical examination shows normal testicular volume and normal male hair distribution. Which of the following is the next most appropriate step in management?


A.Chromosome analysis
B.Serum gonadotropins
C.Serum β-human chorionic gonadotropin (β-hCG) test
D.Surgical consult
E.No further evaluation
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  #2  
Old 06-19-2012
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due to the hormonal changes of puberty?

i would say E, no further evaluation
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Old 06-19-2012
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E. no further evaluation?

i think a bit of gynaecomastia is not worrisome in newborns, pubertals and elderly. Thats what goljan said.
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  #4  
Old 06-19-2012
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Answer is e
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Old 06-19-2012
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i would go with D because its tender
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Old 06-19-2012
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Its E) No further evaluation.

Male breast tenderness/enlargement is normal when going through puberty. Thankfully it subsides
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Old 06-19-2012
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the tenderness thing made me double check too, but i dont know i think its normal
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Old 06-19-2012
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i think tenderness can be due to horomonal changes too. I mean if females can have "cyclical mastalgia"
I still think its E
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Old 06-19-2012
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Eeeeeeeeeeeeee
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Old 06-19-2012
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its E......completely physiological....
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Old 06-19-2012
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i would go with ans b...........tel me rite ans
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Old 06-20-2012
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e .no further evaluation as it is physiological gynaecomastia of puberty
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Old 06-21-2012
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E)CORRECT
Physiologic gynecomastia is normal in
newborns (estrogen stimulation from the mother in utero),
puberty (peaks at ages 13Ė14), and
the elderly (occurs between 50 and 80 years of age)


Option A. Klinefelterís syndrome (47,XXY) is associated with atrophy of the testicles (decreased testicular volume), gynecomastia, and a female hair distribution due to hyperestrinism. However, chromosome analysis is not necessary in this patient, because the testicular volume and male hair distribution are normal.

Option B. Serum gonadotropins (follicle-stimulating hormone and luteinizing hormone) are usually tested when Klinefelterís syndrome is a suspected cause of gynecomastia. Klinefelterís syndrome (47,XXY) is associated with atrophy of the testicles, gynecomastia, and a female hair distribution due to hyperestrinism. Serum gonadotropins are increased. However, serum gonadotropins are not necessary in this patient, because the testicular volume and male hair distribution are normal.

Option C. β-hCG is a luteinizing hormone analogue that can cause gynecomastia. However, it is most often produced by trophoblastic tissue in testicular cancer (choriocarcinoma). A serum β-hCG test is not necessary in this patient, because the testicular examination is normal.

Option D. Gynecomastia in an adolescent is a normal finding and does not require surgery in most cases.
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Old 05-07-2015
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Quote:
Originally Posted by one_destiny View Post
A 13-year-old boy has a tender subareolar mass in the left breast. Physical examination shows normal testicular volume and normal male hair distribution. Which of the following is the next most appropriate step in management?


A.Chromosome analysis
B.Serum gonadotropins
C.Serum β-human chorionic gonadotropin (β-hCG) test
D.Surgical consult
E.No further evaluation

The answer is E
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