Differential diagnosis.

Gynecomastia must be distinguished from cancer, adenofibromas, adenomas, cystic mastopathy.
The mastitis of young men is closely related to the early stage of gynecomastia, which in most cases takes place upon the onset of puberty.
Idiopathic gynecomastia occurs in children and in the pre-Tuberan period without signs of somatic and endocrine abnormalities. But it is rare.
Drug gynecomastia can develop in adolescents involved in bodybuilding, building muscle and abusing anabolic steroids (retabolil).

Iatrogenic gynecomastia may occur. Thus, exogenous sex hormones, both male and female, can be increased, digitalis preparations, phenothiazides, methyldopa, reserpine and other rauwolfia alkaloids, antituberculous derivatives of GINK (with long courses of therapy), spironolactone, etc., can cause an increase in mammary glands. cause contraceptives (engorgement of the mammary glands).
False gynecomastia (pseudogynecomastia) – often reduced to an increase in the amount of fatty tissue with very moderate or absent glandular hyperplasia. It is set on palpation: fatty tissue is softer than glandular.
Diagnostics. If gynecomastia does not decrease with age, but increases, then a special examination is required.

Adolescents with gynecomastia should be consulted by a breast specialist with detailed special examination if indicated. In doubtful cases, use mammography. The question of biopsy of suspicious areas of mammary gland tissue in boys is easier to solve than in girls.
If a teenager simultaneously has signs of incomplete masculinization, then it is necessary to suspect either a violation of testosterone production or resistance to androgens. If an increase in one testicle is found, it is necessary to exclude the testicular tumor.
Treatment. Especially calming a teenager with juvenile gynecomastia is the father’s message that he “had this, too, but soon passed away”. With pubertal transient gynecomastia, drug treatment should not be performed.

If juvenile gynecomastia lasts longer than 2 years, then surgical treatment may be necessary. If the size of the mammary glands is more than 3.5 cm in diameter, then treatment is also required. In such cases, you can try to treat ginkomastiya parlodel. It can also be treated with clomiphen, clomiphene citrate. Used in the treatment of drugs such as danazol (danatrol). There have been reports of a positive effect of dihydrotestosterone (androstanolone) in the form of skin applications.
including in animal experiments, but so far as medicine is difficult to access.
If the enlargement of the mammary glands creates a pronounced cosmetic defect and brings great experiences to the adolescent, the ridicule of peers, then you can resort to cosmetic surgery.
For pathological gynecomastia, treatment is etiologous.
Male sex hormones are not used now, since they themselves can cause gynecomastia. However, intramuscular injection of testosterone can reduce the size of the mammary glands, although the effect is unpredictable, since testosterone increases aromatase activity and enhances its conversion to the female sex hormone estradiol.

A positive effect can be obtained by wearing a tight lyphoid-shaped bandage.
Clinical examination. A patient with gynecomastia needs regular follow-up and even examination in a hospital setting.
Repeated consultation of a specialist should be after 2 years. Patients with the nodal form of gynecomastia should be under medical supervision.
It is important to reduce the body weight of adolescents, since a decrease in adipose tissue is accompanied by a decrease in the mammary gland tissue of the mammary glands.
Examination issues. When pubertal gynecomastia, expert questions arise, as a rule, among young men. Young men with pubertal gynecomastia are in the 2nd group of health.
Youths with a cosmetically pronounced pubertal gynecomastia and in cases of delayed reversal of their development are given a deferment from military service, but only after a thorough clinical examination in an endocrinological hospital.

Adolescents with gynecomastia caused by feminizing tumors of different localization, even with successful surgical treatment, need constant follow-up, are not eligible for military service, are not taken into account and are not accepted for military education.
In case of idiopathic and false gynecomastia, in cases of successful cosmetic operations, young men may be called up for military service on general grounds. The question of the admission of such adolescents to military schools is decided individually.

local_offerevent_note March 11, 2019

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