A 13 year old boy has bilateral gynecomastia. His height is 148 cm, weight 58 kg; the sexual maturity rating is stage 2. The gynecomastia is most likely due to -

Ans. is 'c' i.e., Pubeal gynecomastia o It is a case of pubeal gynecomastia. o Both the sexual and physical growth of the boy is normal for his age. o The boy belongs to the early adolescent group and his SMR (sexual maturity rating) is 2 which is normal for his age. Physiological pubeal gynecomastia o Development of gynecomastia in early to mid pubey in some boys o It can be both unilateral and bilateral o The breast may present with transitory tenderness o The breast regresses spontaneously and rarely persists for more than 2 years Mean concentration of all the Sex hormones such as FSH, LH, Prolactin, Testosterone, Estrone and Estradiol are normal. About other options: ? Testicular tumour - The sexual maturity rating of the boy will be altered because of the alteration in the level of the sexual hormone level . Chronic liver disease - Chronic liver disease can also cause gynecomastia, but the patient will present with signs and symptoms of Chronic liver disease along with Gynecomastia. Prolactinoma - Prolactinoma are more common in adolescent females but can also present in adolescent males. Most of the patients will present with loss of libido and signs of visual field defects.