Gynecologic emergencies

Breast disorders Common breast disorders for which emergency care is sought include neonatal hypertrophy, premature thelarche (either alone or with precocious puberty), absence of breast development, asymmetry, breast masses, breast abscesses, and gynecomastia. Clinical presentation Neonatal breast hypertrophy Neonatal breast hypertrophy occurs in up to two-thirds of normal newborns of both genders. It results from maternal hormonal stimulation, and presents as palpable breast tissue, present from birth, in an otherwise healthy infant. Occasionally, in female infants, there is also galactorrhea, clitoral hypertrophy, and a bloody vaginal discharge, also resulting from the effect of maternal hormones. Most cases resolve within a month, although breast hypertrophy may persist for several months. Premature thelarche Premature thelarche is defined as breast enlargement in the absence of other signs of puberty in a female <9 years of age, but it is most common in girls <5 years old. At times it is the result of neonatal breast hypertrophy failing to regress. Bilateral breast buds (2–4 cm) are present with no associated nipple or areolar change. The patient will not have nipple discharge, axillary or pubic hair, clitoral enlargement, or acne. She will also not have had a growth spurt. The presence of any of these other findings suggests more significant pathology, including true precocious puberty, CNS disorders, ovarian tumors, and exogenous estrogens. Absence of breast development Adolescents may present with a complaint of no breast development. In an otherwise healthy patient with other pubertal signs (pubic hair, pubertal genitalia, menses), it is likely that she has normal breasts, albeit small.