Abstract 25: Clinical and etiological aspects of gynecomastia in 270 patients presenting to a tertiary care centre

Objectives: To evaluate the presenting features, biochemical profile, and etiology of gynecomastia in patients presenting to a tertiary care centre. Methods: The medical records of 293 patients presenting with gynaecomastia were evaluated. Patients with pseudogynaecomastia or inadequate data for analysis were excluded (n = 23). All patients underwent {CBC, LFT, and RFT}prior to FSH, LH, Testosterone, PRL, and TFT (CLIA). β-HCG, alpha-fetoprotein, DHEAS, and ultrasound testes were done as indicated. Results: The median age at presentation was 19.0 years (range 10- 72 years). The median duration of symptoms at the time of presentation was 24 months. The most common symptoms at presentation were pain (57.4%), and aesthetic concerns (21%). Bilateral gynecomastia was seen in 71.33% of patients. Younger subjects (<18-30 years) predominantly sought medical attention. The majority of patients less than 18 years were diagnosed with pubertal gynecomastia. Two patients aged 17 and 27 were found to have Klinefelter's syndrome on evaluation of gynecomastia. An etiology and age-based analysis showed that pharmaceutical drugs (31-40 years), anabolic steroids and chronic alcoholism (19-30 years) and primary gonadal failure (> 40 years) were common in the various age groups. No cause for the gynaecomastia was found in 44.3%, of the subjects (Idiopathic) Subjects in the idiopathic group were eugonadal. Tanner stage B2 was frequent in the Idiopathic and pubertal gynecomastia groups whereas it was B3 in pharmaceutical drugs and the Klinefelter's syndrome groups. The most common drug implicated in our cohort was Anti-retroviral drugs followed by Spironolactone. A longer duration of symptoms was seen in patients of drug-induced gynecomastia (34.15 +-4.21 months, P < 0.0001) compared to the idiopathic group (27.03 +-3.17 months). Bilateral was more common than unilateral gynecomastia across all etiologies. When compared to the unilateral group, patients with bilateral gynecomastia had a longer duration of illness (p = 0.0164), higher BMI (p < 0.001), and low testosterone levels (p = 0.021). Conclusions: Patients with gynecomastia presented more often with pain and aesthetic concerns. A careful evaluation of patients presenting peri-pubertally is warranted. An in-depthhistory of medical illness and medications and/or drug abuse is mandatory prior to proceeding with laboratory investigations. Follow up is mandatory in patients with gynaecomastia in whom no aetiology is discernible on first evaluation.