referral criteria from primary care - gynaecomastia

Last edited 09/2019 and last reviewed 10/2020

• GPs - When and Where to Refer (1)
  
  
  • Abnormal endocrine (hormonal) blood results - note if a marginally raised prolactin then repeat before considering referral
    • Refer to Medical Endocrinology clinic
      
      
  • Abnormal sHCG or alpha fetoprotein blood results or abnormal finding on testicular USS
    • Refer to Urology Clinic urgently
      
      
  • Referral directly to the Breast Unit
    • In the presence of the following clinical scenarios, a referral directly to the local breast unit may be considered.
      • 1. Clinical suspicion of malignancy
        • >50 year old man with unilateral firm sub-areolar mass with or without nipple discharge or with associated skin change
        • Bloody nipple discharge
        • Unilateral ulceration of the nipple
        • Urgent referral is appropriate
      • 2. Unilateral lump with
        • No obvious physiological or drug cause
        • Increased risk - family history
        • Genetic conditions e.g. Klinfelter's Syndrome
        • Urgent referral is appropriate
      • 3. Persistent painful gynaecomastia (>6 months) with normal blood tests

Reference:

• (1) Association of Breast Surgery Summary Statement (June 2019). Investigation and management of gynaecomastia in primary and secondary care.