<prompt> Gynaecomastia is seen in all of the following conditions exceptProlactinomaTSH secreting adenomaHCG secreting tumorEstrogen secreting tumor  <response>: Ans. is a, i.e. ProlactinomaRef: Harrisons 18thed, p2889, Schwartz 7thed, p541; Schwartz 7thed, p541; Behl 9thed, p223Gynaecomastia implies presence of female type mammary glands in male.It can be:PhysiologicalQPathologicalQNeonatal periodQ SystemicQAdolescenceQ excessSenescenceQ androgensQDt EstrogenQ intake diseasesDt decreasedDrugsQ Occurs bw 12 and 15 yearsQ UnilateralQ Occurs bw 50 and 70 yearsQ BilateralQ Causes of Gynaecomastia:I. Estrogen excess states:A. Gonadal origin:1. True hermaphroditism2. Gonadal stromal Nongerminal neoplasm of testis:- Leydig cell interstitialQ- Sertoli cellQ- Granulosa-thecaQ3. Germ cell tumours:- ChoriocarcinomaQ- Seminoma, teratomaQ- Embryonal carcinomaQB. Nontesticular tumours:1. Skin-nevus2. Adrenal cortical NeoplasmsQ3. Lung carcinomaQ4. Hepatocellular carcinomaQC. Endocrine disorders:1. HypothyroidismQ2. HyperthyroidismQD. Disease of the liver - Non-alcoholic and alcoholic cirrhosisE. Nutrition alteration states: Starvation As pituitary adrenal axis is suppressedII. Androgen deficiency states:A. Senescent causes with agingB. Hypoandrogen state hypogonadism1. Primary testicular failurea. Klienfelter syndrome XXYQb. Reifenstein syndrome, XYQc. Rosewater, Gwinup, Hamwi familial gynecomastia XYd. Kallmann syndromeQe. Kennedy disease with associated gynaecomastiaQf. Eunuchoidal males Congenital anorchiaQg. Hereditary defects of androgen biosynthesish. ACTH deficiency2. Secondary testicular failure:a. TraumaQb. Orchitis: due to mumps and leprosyQc. CrytorchidismQd. IrradiationQe. HydroceleQf. VaricoceleQg. SpermatoceleC. Renal failureIII. Drug related conditions that initiate gynaecomastia1. EstrogenQ2. DigitalisQ3. SpironolactoneQ4. MethyldopaQ5. CaptoprilQ6. Calcium Channel blockerQ7. Cimetidine high dosesQ8. KetoconazoleQ9. Tricyclic AntidepressantQ10. DiazepamQIV. Systemic disease with idiopathic mechanismsA. Non-neoplastic disease of the lungB. Trauma chest wallC. CNS - related causes from anxiety and stressD. AIDS Acquired Immunodeficiency Syndrome 