gynecomastia

A 55-year-old man presents to his general practitioner with a six-month history of bilateral breast tenderness and swelling. He is otherwise asymptomatic, reporting no nipple discharge, skin changes, or palpable lumps. His medical history includes well-controlled hypertension on amlodipine. He denies illicit drug use or significant alcohol intake. On examination, the finding shown in the image is noted. Given this presentation, what is the most appropriate initial diagnostic step?

A 58-year-old man presents to his general practitioner expressing concern about the appearance of his chest, which he feels has become more prominent over the past 18 months. He denies any pain, tenderness, or nipple discharge. His medical history includes well-controlled hypertension managed with perindopril and occasional use of ibuprofen for mild osteoarthritis. He reports no significant changes in weight, appetite, or energy levels. He is a non-smoker and drinks alcohol socially, approximately 5 standard drinks per week. He works as an accountant and reports no exposure to unusual chemicals or substances. On physical examination, his vital signs are within normal limits. Abdominal examination reveals no hepatosplenomegaly. Testicular examination is normal in size and consistency, with no palpable masses. The image provided shows the appearance of his chest. Considering the patient's presentation and the visual finding, what is the most appropriate initial investigation to pursue?

A 55-year-old male presents to his GP complaining of bilateral breast tenderness and swelling over the past 6 months. He denies nipple discharge, weight changes, or other systemic symptoms. His vital signs are normal. He takes no regular medications. Considering the clinical presentation and the provided image, which of the following investigations is the most appropriate initial step in evaluating this patient?

A 55-year-old male presents to his GP complaining of bilateral breast tenderness and swelling over the past six months. He denies nipple discharge, weight changes, or other systemic symptoms. His past medical history is unremarkable, and he takes no regular medications. Physical examination reveals the findings shown in the image. His vital signs are within normal limits. Considering the most likely underlying cause suggested by the clinical presentation and image, which of the following is the most appropriate initial investigation?

A 48-year-old man presents with a 2-year history of progressive, tender breast enlargement causing significant distress. Initial investigations including liver function tests, renal function tests, and basic hormonal assays (LH, FSH, testosterone, oestradiol) were largely within normal limits, except for a mildly elevated oestradiol. He takes no regular medications and denies recreational drug use. He is otherwise well and his physical examination is unremarkable apart from the findings shown in the image. Considering the clinical presentation and the findings, what is the most appropriate next step in his management?

A 62-year-old man presents with a 4-month history of bilateral breast enlargement and tenderness. He denies weight loss, fever, or changes in bowel habit. His medical history includes hypertension managed with amlodipine. On examination, vital signs are stable. The physical findings are demonstrated in the image. There is no palpable testicular mass. Given the clinical presentation and the findings shown, which of the following investigations is the most appropriate initial step to determine the underlying cause?

A 58-year-old male presents with concerns about breast enlargement over the past year. He denies pain or nipple discharge. He takes no medications and has no known medical conditions. Examination reveals the findings in the image. What is the MOST appropriate initial investigation?

A 58-year-old male presents with concerns about breast enlargement over the past year. He denies pain or nipple discharge. He takes no medications and reports no significant past medical history. Examination reveals the findings in the image. What is the MOST appropriate initial investigation?

A 58-year-old man presents with concerns about breast enlargement over the past year. He denies pain or nipple discharge. He takes medication for hypertension. Examination reveals the findings in the image. Which of the following is the MOST appropriate initial investigation?

A 58-year-old man presents with concerns about breast enlargement. Examination reveals the findings in the image. Which of the following is the MOST appropriate initial investigation?

A 62-year-old man presents with bilateral breast enlargement, as shown. He denies pain or nipple discharge. What is the MOST likely underlying cause?

A 62-year-old male presents with bilateral breast enlargement for 6 months. He denies pain, discharge, or skin changes. He reports taking saw palmetto for BPH. Examination reveals the findings in the image. What is the MOST likely cause?

A 55-year-old male presents to his GP with bilateral breast tenderness and swelling over six months. He denies nipple discharge or other systemic symptoms. Past medical history is unremarkable, and he takes no regular medications. Physical examination reveals the findings shown in the image. Vital signs are normal. Initial investigations including liver function tests, renal function tests, thyroid function tests, LH, FSH, prolactin, and testosterone are all within normal limits. Considering the clinical presentation, image findings, and normal initial investigations, which of the following is the most appropriate next step in the evaluation of this patient?

A 55-year-old male presents with bilateral breast tenderness and swelling. He denies nipple discharge or systemic symptoms. His vitals are normal, and he takes no medications. Considering the clinical presentation and the findings depicted, which hormonal imbalance is most commonly implicated in the development of this condition in a male of this age group?

A 55-year-old man presents with the condition shown. He reports taking spironolactone for hypertension. What is the MOST appropriate next step?

A 58-year-old man presents with concerns about breast enlargement over the past year. He denies pain or tenderness. He takes medication for hypertension. Examination reveals the findings in the image. Which of the following is the MOST appropriate initial investigation?

A 58-year-old male presents to his GP complaining of bilateral breast enlargement over the past year. He denies any pain or tenderness. He takes no medications and reports no significant past medical history. Examination reveals the findings in the image. What is the MOST appropriate initial investigation?