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and increase in adipose tissue mass with consequent augmentation in periph-
eral aromatization.
- How to differentiate between gynecomastia and lipomastia?
The presence of subareolar adipose tissue without glandular tissue is termed as
lipomastia or pseudogynecomastia. Lipomastia can be clinically differentiated
from gynecomastia by palpation of subareolar tissue or comparison of subareo-
lar tissue with subcutaneous fat in anterior axillary fold. Ultrasonography and
FNAC, if required, can be performed to confirm the presence or absence of
glandular tissue. The differentiation between gynecomastia and lipomastia is
important to avoid anxiety and unnecessary evaluation.
- What is pubertal gynecomastia?
Gynecomastia is common during early to midpuberty and usually occurs at the
age of 13–14 years or during pubic hair stage P 3 to P 4. It is usually bilateral;
however, 25 % of adolescents may have unilateral gynecomastia. Pubertal
gynecomastia is painful in majority (70 %) because of rapid enlargement of the
breast. It usually regresses within 2–3 years, but 10 % of patients may have
persistent gynecomastia. Pubertal gynecomastia is a result of inappropriate
increase in serum estradiol levels in comparison to testosterone, thereby lead-
ing to altered testosterone/estradiol ratio (Fig. 7.16).
a b
Fig. 7.16 (a) A 13-year-old boy with bilateral gynecomastia, (b) a testicular volume of 6 ml sug-
gests that the boy has entered into puberty
7 Delayed Puberty