From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock.
South Med J. 2022 Aug;115(8):597-602. doi: 10.14423/SMJ.0000000000001425.
Gynecomastia is a more common finding in primary care clinics than is recognized. Because this finding can be easily overlooked, appropriate investigation and management often are missed. The workup of gynecomastia is highly individualized, based on the patient's presentation and related factors. It should be guided by thorough history taking and physical examination. Unless the patient has associated symptoms, or there is suspicion for an underlying clinical disorder causing the gynecomastia, the patient need not be investigated further. A breast ultrasound is not routinely recommended. Gynecomastia is a benign finding that will spontaneously regress in most patients; however, patients who are concerned with their physical appearance can be treated either medically or surgically. Patients who have had gynecomastia for more than 1 year tend to have fibrosis, which may be more difficult to treat. Management of gynecomastia is highly patient centered, following a detailed discussion about treatment goals and should be started early. Gynecomastia is not considered a premalignant condition; routine screening is not cost-effective, and imaging studies should be pursued only if physical examination findings suggest malignancy.
男性乳房发育症在初级保健诊所比人们认识到的更为常见。由于这种情况很容易被忽视，因此经常会错过适当的检查和治疗。男性乳房发育症的检查高度个体化，取决于患者的表现和相关因素。应通过详细的病史采集和体格检查来指导。除非患者有相关症状，或怀疑存在导致男性乳房发育症的潜在临床疾病，否则无需进一步检查。通常不建议进行乳房超声检查。男性乳房发育症是一种良性病变，大多数患者会自行消退；但是，对于那些对自己的外表感到担忧的患者，可以采用药物或手术治疗。患有男性乳房发育症超过 1 年的患者往往会出现纤维化，这可能更难治疗。男性乳房发育症的治疗以患者为中心，在详细讨论治疗目标后开始，并应尽早进行。男性乳房发育症不被认为是癌前病变；常规筛查没有经济效益，只有在体格检查结果提示恶性肿瘤时才应进行影像学检查。
