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A mother brings in here 14 year old son after she noticed his appearance at the beach. She asks her son to show you and proceeds to leave the room. The boy, clearly embarrassed, takes off his shirt to reveal moderate asymmetric gynecomastia. He has no medical history and is on no medication. Examination showed breast tissue that's moderately tender to palpation bilaterally with no masses or discharges or skin changes. Boy's at Tanner stage 3 of development. The mother kicks back in and asks what are the treatment options. What you should tell her?

A - The boy may have pituitary tumor and needs further work up.
B - The boy may have testicular tumor and needs further work up.
C - No need for treatment and this is normal development.
D - Plastic cosmetic surgery can be helpful at this point
E - Several hormonal assessments needed before we can decide the diagnosis and treatment.
 

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As far as this boy's normal development has not been completed yet (Tanner 3 stage), I would say that this is a normal variation (puberty is a period of cataclysmic hormonal changes and alternations) and I would suggest no further investigation at this point (choice C).

A diagnostic challenge here might have been Klinefelter syndrome, but this would demand karyotyping, which is not an available option.

I actually had a similar case during my military service as a corps physician and referred the boy (he was actually 18yo) to an endocrinologist, who did not show empathy to my inquietude... :eek:
 
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