Clinical study of patient

Exclusion of cancer through clinical examination is enough: asymmetry, fixation, ulceration, axillary lymph nodes.

Gynecomastia
Rubbery mass below and above the nipple areola-pintch test tο control gland + - fat, drop skin test
Time duration and record of pain. Recent cases of gynecomastia require investigation.
Systemic diseases, hypogonadism (testicular length <3cm, lack of hair growth), cirrhosis, hyperthyroidism, recent weight loss, weight gain, tumour control, alcoholism.
Taking medicines.
Laboratory control which depends on the evaluation of the patient’s history and the clinical check-up. It is not advisable in all cases.
Tests: Hcg (for ca), 17 ketosteroeidi urine diydroepiandrostendioni (adrenal ca), serum estradiol (tumors of Leyding cells), gonadotropins and testosterone (hypogonadism), prolactin (hyperprolactinemia, pituitary tumors).