A 13-year-old Indian boy presented with progressive non-painful enlargement of bilateral breasts for 2 years. (Figure1) There was no history of any drug intake that could lead to gynaecomastia with no significant past medical history. His BMI was 28.5 kg/m2, no icterus, no stigmata of liver disease, acanthosis was present, sexual maturity rating P1 A1, and stretched penile length was 5 cm, testicular volume 3 ml bilaterally of normal consistency; with a bone age of 13 years and a disc diameter of 6 cm bilaterally. Investigations revealed normal liver function tests, fasting testosterone levels of 67 ng/dl, LH 1.17 U/L, FSH 3.68 U/L, FBS 90 mg %, and PPBS 107 mg%. Considering the overall clinical picture, a diagnosis of Peripubertal Gynaecomastia was made. Obesity could have been a contributing factor to the development of this condition in this patient. He denied having taken any estrogenic compounds but environmental exposure cannot be ruled out as we did not assay for the levels of these environmental endocrine disruptors and estrogenic agents. However, increased pigmentation of nipples and areola is a common feature of gynaecomastia due to exogenous synthetic estrogen exposure which was absent in this case.
Puberty ; Mammaplasty