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Do Adolescents with Gynecomastia Require Routine Evaluation by Endocrinology?

Malhotra, Armaan K.; Amed, Shazhan, M.Sc., M.D.; Bucevska, Marija, M.D.; Bush, Kevin L., M.D.; Arneja, Jugpal S., M.D., M.B.A.

Plastic and Reconstructive Surgery: July 2018 - Volume 142 - Issue 1 - p 9e-16e
doi: 10.1097/PRS.0000000000004465
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Background: Primary evidence for the role of endocrinologic investigations in patients with adolescent gynecomastia is lacking in the current literature. The objective of this study was to assess the yield of endocrinologic investigations in the evaluation of adolescent gynecomastia to inform current practice for this common condition.

Methods: A 26-year retrospective review was conducted. Data collection included patients with gynecomastia presenting to endocrinology at a quaternary children's hospital with a catchment area of 1 million. Clinical metrics, endocrinologic results, treatments, and costs were reviewed.

Results: One hundred ninety-seven patients met inclusion criteria. Ninety-eight (50 percent) were overweight or obese and 29 (15 percent) had a positive family history. The median age at onset was 11.5 years; 25 cases (13 percent) were prepubertal. A total of 15 patients (7.6 percent) were diagnosed with secondary gynecomastia (10 related to exogenous substance use). Endocrine investigations were performed in 173 patients (87 percent), with positive findings in three cases (1.7 percent). One hundred one patients were observed, with a median age at resolution of 14.6 years; 86 patients underwent surgery at a median age of 16.5 years. The case-cost of endocrine evaluation was $389.

Conclusions: Endocrinologic workup identified secondary gynecomastia in 7.6 percent of patients, of which only 1.7 percent were evident on blood work. This workup is associated with an avoidable case-cost burden to the health care system and largely unnecessary testing for the child. Because a majority of secondary gynecomastia cases (67 percent) were drug-induced, we do not suggest routine endocrinology workup, as it adds little value. The authors’ data suggest that referral for surgery is warranted if gynecomastia persists beyond 16 years of age.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

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Vancouver, British Columbia, Canada

From the Faculty of Medicine, the Division of Endocrinology and Diabetes, Department of Pediatrics, and the Division of Plastic Surgery, Department of Surgery, University of British Columbia; and the Division of Endocrinology and Diabetes, Department of Pediatrics, and the Division of Plastic Surgery, Department of Surgery, BC Children’s Hospital.

Received for publication July 24, 2017; accepted January 5, 2018.

Presented at the 71st Annual Meeting of the Canadian Society of Plastic Surgeons, in Winnipeg, Manitoba, Canada, June 20 through 24, 2017.

Disclosure:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch. On the iPad, tap on the Hot Topics icon.

Jugpal S. Arneja, M.D., M.B.A., Division of Plastic Surgery, BC Children’s Hospital, 4480 Oak Street, Room K3-131 ACB, Vancouver, British Columbia V6H 3V4, Canada, jarneja@cw.bc.ca

Copyright © 2018 by the American Society of Plastic Surgeons