A 13 years and 9 months old overweight male, 65 kg and 152 cm tall. Non-consanguineous marriage. FT, AGA(3.7KG)LSCS to G1P1A0 IDM baby with the good Apgar score. Normal development history, normal IQ, no dysmorphic feature. He was fed formula milk (PediaSure) for all most 2 yrs. Initial childhood, he was slim, and he started to gain weight after 7 yrs of age. This patient is steadily increasing his weight and has developed profound B/L gynecomastia. Fat deposition on his tummy and his voice is not yet changed and has a normal penis but a little smaller in size. Testis are of normal volume. The father's height is 158 cm, mother's height is 155 cm. Parents attended puberty normally. CNS and Fundus exam normal. No crossing of centiles. Baseline: All routine investigation has done as follows: Insulin (did on 15.01.2018) - 85 increased (normally less than 25). 29.10.2018 - 45 increased. Free T3 (done thrice) - increased. Creatine - decreased. ALT - decreased.
What can be the probable diagnosis of his gynecomastia? Please suggest proper treatment and management. I am worried about his gynecomastia. He is a decent, well-behaved, and intelligent child, but with a sedentary lifestyle. Please help this child to reach a diagnosis.
As the patient has attained puberty normally, it seems he has just been obese from energy imbalance due to sedentary lifestyle during his childhood. This problem has been compounded by pubertal gynaecomastia. He would be OK with proper lifestyle and diet, I hope. He is also at risk of developing diabetes or glucose intolerance early. He should, for his age, play/exercise at least an hour a day. If his gynaecomastia persists after passing puberty and losing weight, medical and surgical options are available.
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