Gynecomastia: The Daily PANCE Blueprint
A 22-year-old male with Klinefelter syndrome presents with gradual breast enlargement. Which lab abnormality is most likely?
A. Increased estrogen/testosterone ratio
B. Elevated prolactin level
C. Markedly elevated AFP
D. Low TSH
E. Elevated progesterone
Answer and topic summary
The answer is A. Increased estrogen/testosterone ratio
Gynecomastia is defined as mammary gland tissue proliferation in males. It can be due to an increased estrogen/testosterone ratio but can also be idiopathic as well. Specific causes include cancer, hyperthyroidism, Klinefelter syndrome, CKD, hypogonadism, and medications (e.g., finasteride, cimetidine, ketoconazole, spironolactone, androgenic steroids, opioids, etc). Workup may include CMP, thyroid function test, sex hormone profile, AFP, hCG, etc. Imaging is not routinely recommended. Treatment includes managing the underlying cause.
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