Gynaecomastia

Gynaecomastia is benign hypertrophy of male breast and the examination of such a patient should aim to find a probable cause and to exclude breast carcinoma (rare). 
Hence the sequence of examination should follow that of the female breast.

1. Expose the patient up to the waist.
2. Note whether it is unilateral or bilateral gynaecomastia (If unilateral - exclude CA breast).
3. Look for changes of the overlying skin and nipple. 
4. Check whether it is painful or painless gynaecomastia.
5. Palpate all four quadrants of both breasts & axillae and check for any palpable lumps. 
6. Look for a probable cause,

• Signs of alcoholic liver disease - Parotid enlargement, Loss of body hair, Ascites, Spider naevi.
• Examine testis - Orchiectomized? Atrophied? Tumours?
• Klinefelter's syndrome -Tall? 
• Examine signs of hypo/hyperthyroidism.
• Offer to take a brief drug history - Cimetidine, Spironolactone, Digoxin.

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