A 15-year-old boy is brought to your office because of concerns about his breast development.

Comprehensive and Detailed Explanation:

The image and clinical history are consistent with physiologic pubertal gynecomastia, which is common in adolescent boys. It usually resolves spontaneously within 6 months to 2 years and does not require investigation unless other signs of endocrine pathology are present.

Toronto Notes 2023 – Pediatrics / Endocrinology:

“Pubertal gynecomastia is benign, self-limited, and common in adolescent males. No further investigation is needed in the absence of systemic signs.”

MCCQE1 Objectives (Pediatrics > 77-2: Endocrine Disorders):

“Candidates must differentiate physiologic gynecomastia from pathologic causes based on history and physical exam.”

Other tests (A–C, E) are unnecessary unless there are red flags (e.g., testicular mass, rapid progression, neurological symptoms).

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