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Pseudogynecomastia = breast enlargement due to non-breast fatty tissue

Gynecomastia = breast enlargement due to enlargement of breast tissue

DD of pseudogynecomastia:
- fat deposition - neurofibromatosis
- neoplasm - factitious

DD of Gynecomastia:
1- physiological:
- neonate (due to ingestion of maternal estrogen)
- puberty
- old age

2- pathological:
A- increase estrogen:
- estrogen-secreting testicular tumor (leydig cell tumor)
- estrogen-secreting adrenal tumor
- exogenous estrogen use (as treatment of prostatic carcinoma)
- alcoholism (damage leydig cell)
- obesity - liver disease
- hereditary - thyrotoxicosis

B- decrease androgen:
- hCG-producing tumors (testicular tumor, bronchial carcinoma, lung cancer,
carcinoid tumors of lung + GIT)
- endocrinopathies (acromegaly, cushing's syndrome, true hermaphroditism,
klinefelter's syndrome, adrenal agenesis)
- testicular failure (orchitis, castration, trauma)

C- others: chronic illness, starvation / refeeding, renal failure, local trauma,

pituitary tumor (prolactinoma), intrathoracic malignancy, paraplegia,
erthroderma, idiopathic

D- drugs:
- Estrogen - spironolactone - diazepam
- cimetidine - digitalis - cytotoxic drugs
- griseofulvin - amphetamines - methyldopa
- phenytoin - tricyclic antidepressants - testosterone
- isoniazid - ca channel antagonist - marijuana
- histamine antagonist

Done by Dr.Wala'a Gholam

- Churchill’s pocketbook of differential diagnosis

- Harrison’s manual of medicine

- Bedside medicine without tears by SN Chugh

- Clinical examination by Nicholas J Talley

- Self assessment Questions in internal medicine by dr. Daad and dr. Maimoona

- Browse’s introduction to the symptoms and signs of surgical diseases

- The mont reid surgical hand book