Male pt.12yrs old having both side of chest (gynaecomastia ) advice for physician allopathic t/t .

10 days old male infant with bilateral mammary swellings. On examination bilateral mobile retro areolar masses ,not fixed to deeper structures 5×4 cms .What is the management

ETIOLOGY OF AMENORRHOEA HYPOTHALAMUS || PITUITARY || ENDOCRINE || OVARIAN || OUTFLOW TRACT AXIS HYPOTHALAMUS: Hypothalamic - hypogonadism ×Weight related amenorrhoea (Anorexia nervosa) PITUITARY Pituitary adenoma. Sheehans syndrome ENDOCRINE Hypothyroidism OVARIAN Gonadal dysgenesis/Turner's syndrome. Gonadal failure. PCOS. OUTFLOW TRACT AXIS Congenital absence of uterus and vagina. Vaginal atresia. Imperforate hymen. Any case requires history,examination and investigations for assessment. CLINICAL ASSESSMENT/HISTORY Ask about 1.Regarding menarche and menstrual history. 2.Previous pregnancies-severe PPH (SHEEHAN'S SYNDROME) 3.Weight change-weight loss (ANOREXIA NERVOSA) 4.Hot flushes,decreased libido (PREMATURE OVARIAN FAILURE) 5.Any intake of medications. 6.Contraception. 7.Associated symptoms Cushings disease Hypothyroidism. 8.Previous gynecological history. 9.Chronic illness. CLINICAL ASSESSMENT/EXAMINATION Check for 1.Body mass index-weight loss (ANOREXIA NERVOSA) 2.BLOOD PRESSURE ELEVATED (CUSHINGS,PCOS) 3.Androgen excess Hirsutism-PCOS Virilization-TUMOUR. 4.Secondary sexual characters. 5.Features of Turners syndrome Webbed neck. Short stature. Increased carrying angle at the elbow Sexual infantilism. Widely spaced nipples. 6.Breast examination-galactorrhoea. 7.Any abdominal masses or pelvic masses. 8.Inspection of genitilia Imperforate hymen. Cervical stenosis. 9.Vaginal examination Blind vagina Vaginal atresia. Absent uterus. INVESTIGATIONS OF PRIMARY AMENORRHEA 1.Blood tests. 2.Ultrasound. 3.CT scan of pituitary. 4.Karyotyping. 5.Laparoscopy. SITE OF DISORDER/DIAGNOSIS/TEST Hypothalamus-Hypothalamic-hypogonadism FSH,LH,ESTRADIOL-LOW Pituitary-pituitary adenoma PROLACTIN-HIGH,S.FSH,LH,E2-LOW Ovary-Gonadal dysgenesis-turner syndrome S.FSH,LH-HIGH ESTRADIOL-LOW KARYOTYPING-45XO Mullerian tract Absent uterus-testicular feminization PROGESTERONE CHALLENGE TEST-NEGATIV KARYOTYPING-46XY. Absent uterus-Mullerian agenesis Normal hormonal profile Karyotyping46XY MRI Genital tract-Imperforate hymen S.FSH,LH,E2-NORMAL PCT-NEGATIVE EXAMINATION-IMPERFORATE HYMEN

Pituitary Adenoma and Hyperprolactinemia Accompanied by Idiopathic Granulomatous Mastitis A thirty-nine-year-old single patient with no children and no history of oral contraceptive use was admitted to our clinic with complaints of redness, pain, and swelling in her left breast (Figure 1). She had no additional illness or complaints (BMI: 33.3). She was a tobacco user (5–10 units/day), within the normal weight category, and had three gravidity. Breast ultrasound revealed irregular limited solid heterogeneous hypoechoic mass lesions suspicious for malignancy; the largest one was 16 mm in diameter. There were no lymph nodes in the left axilla. The mass was categorized BIRADS-4 in breast ultrasonography. Breast MRI revealed heterogeneous enhancement with 3.5 × 5 cm of inflammatory area at the left breast upper outer quadrant. Biopsy was recommended for differential diagnosis of inflammatory breast cancer (Figure 2). Serum C reactive protein (CRP) was high (12.4 mg/l), sedimentation rate was high (37 mm/h), and CA 125 and CA 15-3 levels were normal. Gram (+) cocci were observed in the breast abscess stain; however, abscess culture results were negative. IGM was diagnosed with core biopsy examination (Figure 3). The breast abscess was drained and steroids were given for two months (Prednol 4 mg/day/oral and 0.1% betamethasone pomade) and empiric antibiotics (cefuroxime axetil 500 mg tablets 2 × 1) were given during treatment for ten days. After two months of treatment, there was no improvement. Therefore, body serum hormone profiles were examined. Growth hormone, insulin-like growth factor, thyroid stimulating hormone, estradiol, luteinizing hormone, and follicle-stimulating hormone were normal. However, serum prolactin was elevated (351 ng/ml). Pituitary MRI revealed a 7 × 4 mm sized microadenoma causing pituitary prolactinoma (Figure 4). In order to treat hyperprolactinemia, prolactin inhibitor (Cabergoline) was given to the patient. Cabergoline was started at 1 mg per week; then it increased for six weeks. After prolactin levels returned to normal, it was reduced. Cabergoline treatment was continued for two years. Prolactin levels returned to normal and there was resolution of IGM after 4 months. Follow-up included monitoring of CRP levels. No recurrences were observed during a four-year follow-up period. Read complete discussion at: https://www.hindawi.com/journals/crie/2017/3974291/

patient 20 female unmarried,amnerrhoea 5 months.thyroid level is normal