Variation in the Work Up and Management of Patients with Gynaecomastia
Association of Breast Surgery ePoster Library. Zielicka Z. 05/13/19; 257123; P079
Zofia Zielicka
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P079
Topic: Diagnosis/ Referral
Introduction: Gynaecomastia is a common cause for male patients attending Breast Services. At present, there are no national guidelines on how to investigate or manage gynaecomastia, and therefore a diverse range of approaches exist. We assessed how patients with gynaecomastia are investigated and managed within our unit. Methods After Trust approval (ID 312), we identified 100 patients with gynaecomastia who attended the “one-stop” clinic from November 2017 to October 2018. We reviewed the way in which each of the 7 physicians (5 Breast Surgeon Consultants, 1 GP, 1 Specialist Nurse) investigated and managed gynaecomastia by reviewing pathology, imaging, and clinical documentation. Results: Investigations for all patients included a clinical history, breast examination and imaging. However, there was a variation in whether alcohol history (60%) and testicular symptoms and/or examination (58%) were performed. Patients who had blood tests (56%) either in clinic or by the GP, included testosterone, oestradiol and beta-HCG levels. However, there was a variation in other bloods tests being requested including prolactin, LFTs, TFTs, LH/FSH and SHBG. The majority of patients were managed conservatively (90%). Interestingly, 2 patients were referred to oncology (1=new testicular cancer diagnosis and 1=suspected recurrent testicular cancer). Conclusions: This study identified substantial variation in the work up and management of Gynaecomastia. A ‘male breast proforma'as an aide memoire regarding the tests that should be requested (e.g. bloods, testicular US, etc), how to manage abnormal results and when to refer to Endocrinology, may help standardise management.
Topic: Diagnosis/ Referral
Introduction: Gynaecomastia is a common cause for male patients attending Breast Services. At present, there are no national guidelines on how to investigate or manage gynaecomastia, and therefore a diverse range of approaches exist. We assessed how patients with gynaecomastia are investigated and managed within our unit. Methods After Trust approval (ID 312), we identified 100 patients with gynaecomastia who attended the “one-stop” clinic from November 2017 to October 2018. We reviewed the way in which each of the 7 physicians (5 Breast Surgeon Consultants, 1 GP, 1 Specialist Nurse) investigated and managed gynaecomastia by reviewing pathology, imaging, and clinical documentation. Results: Investigations for all patients included a clinical history, breast examination and imaging. However, there was a variation in whether alcohol history (60%) and testicular symptoms and/or examination (58%) were performed. Patients who had blood tests (56%) either in clinic or by the GP, included testosterone, oestradiol and beta-HCG levels. However, there was a variation in other bloods tests being requested including prolactin, LFTs, TFTs, LH/FSH and SHBG. The majority of patients were managed conservatively (90%). Interestingly, 2 patients were referred to oncology (1=new testicular cancer diagnosis and 1=suspected recurrent testicular cancer). Conclusions: This study identified substantial variation in the work up and management of Gynaecomastia. A ‘male breast proforma'as an aide memoire regarding the tests that should be requested (e.g. bloods, testicular US, etc), how to manage abnormal results and when to refer to Endocrinology, may help standardise management.
P079
Topic: Diagnosis/ Referral
Introduction: Gynaecomastia is a common cause for male patients attending Breast Services. At present, there are no national guidelines on how to investigate or manage gynaecomastia, and therefore a diverse range of approaches exist. We assessed how patients with gynaecomastia are investigated and managed within our unit. Methods After Trust approval (ID 312), we identified 100 patients with gynaecomastia who attended the “one-stop” clinic from November 2017 to October 2018. We reviewed the way in which each of the 7 physicians (5 Breast Surgeon Consultants, 1 GP, 1 Specialist Nurse) investigated and managed gynaecomastia by reviewing pathology, imaging, and clinical documentation. Results: Investigations for all patients included a clinical history, breast examination and imaging. However, there was a variation in whether alcohol history (60%) and testicular symptoms and/or examination (58%) were performed. Patients who had blood tests (56%) either in clinic or by the GP, included testosterone, oestradiol and beta-HCG levels. However, there was a variation in other bloods tests being requested including prolactin, LFTs, TFTs, LH/FSH and SHBG. The majority of patients were managed conservatively (90%). Interestingly, 2 patients were referred to oncology (1=new testicular cancer diagnosis and 1=suspected recurrent testicular cancer). Conclusions: This study identified substantial variation in the work up and management of Gynaecomastia. A ‘male breast proforma'as an aide memoire regarding the tests that should be requested (e.g. bloods, testicular US, etc), how to manage abnormal results and when to refer to Endocrinology, may help standardise management.
Topic: Diagnosis/ Referral
Introduction: Gynaecomastia is a common cause for male patients attending Breast Services. At present, there are no national guidelines on how to investigate or manage gynaecomastia, and therefore a diverse range of approaches exist. We assessed how patients with gynaecomastia are investigated and managed within our unit. Methods After Trust approval (ID 312), we identified 100 patients with gynaecomastia who attended the “one-stop” clinic from November 2017 to October 2018. We reviewed the way in which each of the 7 physicians (5 Breast Surgeon Consultants, 1 GP, 1 Specialist Nurse) investigated and managed gynaecomastia by reviewing pathology, imaging, and clinical documentation. Results: Investigations for all patients included a clinical history, breast examination and imaging. However, there was a variation in whether alcohol history (60%) and testicular symptoms and/or examination (58%) were performed. Patients who had blood tests (56%) either in clinic or by the GP, included testosterone, oestradiol and beta-HCG levels. However, there was a variation in other bloods tests being requested including prolactin, LFTs, TFTs, LH/FSH and SHBG. The majority of patients were managed conservatively (90%). Interestingly, 2 patients were referred to oncology (1=new testicular cancer diagnosis and 1=suspected recurrent testicular cancer). Conclusions: This study identified substantial variation in the work up and management of Gynaecomastia. A ‘male breast proforma'as an aide memoire regarding the tests that should be requested (e.g. bloods, testicular US, etc), how to manage abnormal results and when to refer to Endocrinology, may help standardise management.
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