Clinical features of adolescent gynecomastia:
(1) age of onset 10 to 18 years
(2) normal onset of puberty and normal progression
(3) onset of puberty before development of gynecomastia
(4) testes normal for Tanner puberty stage
(5) gynecomastia as a disc centered beneath the nipple
Features that should not be present:
(1) malnutrition
(2) chronic disease (liver, renal, intestinal, respiratory, endocrine)
(3) family history of gynecomastia
(4) genital disease (orchitis, testicular trauma, hypospadia, cryptorchidism)
(5) testes too small or large, asymmetry, nodular
(6) exposure to a drug implicated as causing gynecomastia
(7) axillary lymphadenopathy
(8) hard breast mass not beneath the nipple
(9) coincident symptoms consistent with an endocrine disorder
