Gynecomastia - Differential Diagnosis Algorithm

No Testicular Mass on Ultrasound

 • Adrenal Neoplasm

 • Increased Extraglomerular Aromatase Activity

 • Liver Disease

Testicular Mass on Ultrasound

 • Leydig Cell Tumor

 • Sertoli Cell Tumor

No Testicular Mass on Ultrasound

 • Extragonadal Germ Cell Tumor

 • HCG Secreting Non-Trophoblastic Neoplasm

Testicular Mass on Ultrasound

 • Testicular Germ Cell Tumor

Increased T4, Decreased TSH

 • Hyperthyroidism

Increased Testosterone

 • Testicular Germ Cell Tumor

Normal T4 and TSH

 • Androgen Resistance

Decreased Testosterone

 • Hypogonadism

 • Klinefelter's Syndrome

 • Kallman's Syndrome

 • Testicular Torsion

 • Testicular Trauma

 • Congenital Anorchia

 • Viral Orchitis

Increased Prolactin

 • Prolactin Secreting Tumor

Normal Prolactin

 • Non-Tumor Secondary Hypogonadism



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