Pediatric emergency medicine trisk 0420 0420

Enlargement of breast tissue may occur at any age. Hypertrophied breast tissue
occurs in the first few weeks of life secondary to maternal estrogen stimulation in
male and female infants. This is a normal physiologic response that abates over
time, parental reassurance is the treatment. Isolated unilateral or bilateral
thelarche may occur in preschool-aged girls. In the absence of development of
secondary sexual characteristics, this is consistent with isolated benign premature
thelarche. Enlargement usually resolves spontaneously within 2 years, though
continued follow-up with a primary care physician is prudent. Breast enlargement
in the setting of secondary sexual characteristics, such as pubic hair (precocious
puberty) in girls, or any breast enlargement in young boys (prepubertal
gynecomastia), is abnormal and additional evaluation indicated. History and
examination focused on the presence of adrenal, ovarian, or hypothalamic
pathology, including hormone-secreting tumors and intracranial tumors, is
indicated. Review recent medication usage as several medications can cause
gynecomastia ( Table 16.1 ). Unless an intracranial mass is suspected, most
children can be referred for outpatient workup with an experienced physician or
endocrinologist.
Fibroadenomas are the most common benign breast lesion (>75%) in the
adolescents. These masses are most often discovered by self-examination. They
are solitary, well-circumscribed, mobile, rubbery, masses located in the upper
outer breast quadrant that are typically <2 to 3 cm in size. Patients often have
intermittent tenderness that is associated with the menstrual cycle. Ultrasound can
be considered to document this diagnosis and help exclude other pathology.
Fibroadenomas can be observed over time; associated malignancy is rare.
Treatment is required for giant fibroadenomas (>5 cm) which may destroy normal
breast tissue; referral to a pediatric or breast surgeon for excisional or core biopsy
is recommended.
Fibrocystic disease is a benign, progressive process generally seen in women
during the reproductive years, but may also present in adolescence. Fibrotic tissue
is most prominent in the upper outer quadrants of the breast and unilateral or
bilateral. Frequently, presentation is that of cyclically painful nodules that change

in size during the course of the menstrual cycle, with the maximal symptoms
during the premenstrual phase. Serosanguinous nipple discharge is rarely present.
Importantly, in the adolescent population, these lesions are not precancerous.
Breast ultrasonography can be used to confirm the diagnosis although neither
needle aspiration nor breast biopsy is required. Treatment is largely symptomatic
with breast support, nonsteroidal analgesics, and avoidance of caffeine. Oral
contraceptive agents can reduce symptoms in severe cases, but are not typically