Pubertal gynecomastia is commonly caused by what mechanism?

• A. Subareolar hyperplasia from estrogen androgen imbalance
• B. Overproduction of prolactin
• C. Breast tissue infection
• D. Primary breast cancer

Answer: (A)

Pubertal gynecomastia results from an estrogen-dominant state during puberty, leading to subareolar hyperplasia of breast tissue. As boys go through puberty, estrogen levels rise and may temporarily exceed androgen activity, stimulating growth of the ductal and connective tissue just beneath the areola. This creates the typical breast enlargement seen in pubertal gynecomastia and is usually self-limited as hormonal balance normalizes.

Why the other ideas aren’t the main mechanism: excess prolactin tends to cause lactation-related changes rather than simple breast enlargement, infection would present with signs of inflammation, and primary breast cancer is exceedingly rare in puberty and would not present as diffuse bilateral glandular enlargement.