A 14-year-old boy has bilateral, tender, discoid subareolar swellings of 8 months duration. Examination confirms symmetrical glandular enlargement without discrete masses, and testicular examination is normal. What is the most appropriate management?
- A Reassurance with review, as most cases resolve spontaneously ✓
- B Subcutaneous mastectomy through a periareolar incision
- C Tamoxifen 20 mg daily for six months
- D Serum beta-hCG and prolactin measurement in all patients
Correct answer: A. Reassurance with review, as most cases resolve spontaneously
Explanation
Pubertal gynecomastia is physiological, appears in up to two thirds of adolescent boys, and regresses spontaneously in the large majority within one to three years, so reassurance with follow-up is correct. Surgery is reserved for persistent enlargement beyond about two years or severe psychological distress. Drug therapy such as tamoxifen is not indicated for physiological pubertal disease, and hormonal workup is needed only when there are red flags like abnormal testes, galactorrhoea or disproportionate virilisation concerns.
Reference: Schwartz's Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.