A 16-year-old boy is concerned about bilateral breast tissue enlargement noticed 8 months ago. Examination reveals 2 cm of firm subareolar breast tissue bilaterally. Testicular volume is 12 mL bilaterally, pubic hair is Tanner stage 4, and there are no testicular masses. Serum testosterone and estradiol are within normal limits. Which of the following is the most appropriate management?
- A Mammography and biopsy of breast tissue
- B Tamoxifen therapy for 3 months
- C Reassurance and follow-up in 6 months ✓
- D MRI of the pituitary gland
Correct answer: C. Reassurance and follow-up in 6 months
Explanation
Pubertal gynecomastia affects up to 50-60% of adolescent boys, typically appearing at Tanner stage 3-4, and is self-limited, resolving within 1-2 years in most cases. Reassurance is the standard management when examination and hormonal profile are normal. Biopsy and imaging are unnecessary without suspicious findings. Tamoxifen may be considered for persistent or distressing cases beyond 2 years but is not first-line. Pituitary MRI is indicated only if there are signs of pathological hyperprolactinemia or central pathology.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.