In a message dated 8.11.98 17:12:56 BST, you write:
>I have recently seen a patient (whilst working as a locum) complaining of
>Gynaecomastia. It was a throw away comment whilst (almost) leaving having
>presented with another minor complaint. He is in his late 40's and on
>regular Lansoprazole, Atenolol (post MI) and Sertraline. No other obvious
>cause
and
> I have a patient in his late 50's who developed unilateral gynaecomastia
> for no apparent cause. It didn't settle so I referred him to the general
> surgeons. He eventually had a mastectomy. Approximately one year later
> he developed an abdominal mass which turned out to be enlarged para-
> aortic nodes full of metastatic seminoma!
> --
> John King
>
This reminds me of a PGEA talk from someone extremely good whose name I have
completely forgotten.
But I did make a note that one should check AFP,LDH and HCG levels in any man
with gynaecomastia because small testicular cancers can produce these hormones
and metastasise before any lump is palpable in the testis. In fact a lump may
never become palpable even when mets are huge and all over the place.
Hence also check these blood tests in cases of unknown primary because
testicular cancer is so treatable.
Also (for the unknown primary) ultrasound the testes
Hopefully your patient will have something "nicer" but it would be reassuring
to check and it's a simple blood test
Good luck :-)
Grace Marshall
Southampton
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