Cost-effective management of gynecomastia

BACKGROUND: Routine endocrine screening of idiopathic gynecomastia has been advocated, but may not be cost effective. We carried out a cost-benefit an alysis of this approach. METHODS: A retrospective study (1992 to 1997) of 87 adult males with sympto matic gynecomastia was performed. RESULTS: Thirty-four (39%) patients had extrinsic causes; 53 (61%) were con sidered idiopathic. Forty-five idiopathic cases underwent endocrine testing : beta human chorionic gonadotropin alone, 16; and beta human chorionic gon adotropin, LH, estradiol, testosterone +/- testicular ultrasound, 29. One ( 2%) occult Leydig cell testicular tumor was detected. Forty-four patients h ad normal studies and remain well after local excision. CONCLUSION: Routine endocrine evaluation of idiopathic gynecomastia is rare ly productive; such testing is best done selectively. Am J Surg. 1998;176:6 38-641. (C) 1998 by Excerpta Medica, Inc.