An Intriguing Case of Gynecomastia in an Elderly Male as the Initial Presentation of Graves' Disease: A Case Report.

Gynecomastia is the proliferation of fibroglandular tissue in the male breast due to an altered hormonal milieu between the inhibitory effect of androgens and the stimulatory effect of estrogens on the breast tissue causing feminization of the male breast. Physiological causes are more common along with a few pathological conditions leading to gynecomastia in the male population. Of these varied etiologies, thyrotoxicosis is one of the notable causes, though it is very rare in the elderly population. Gynecomastia as the initial presentation of Graves' disease that too in an elderly age group is very rare with very few cases reported in the literature. Here, we present a case of a 62-year-old male presenting with gynecomastia, who after a detailed evaluation, was diagnosed to have Graves' disease.

Addressing the Inertia: A Holistic Approach to Diabetic Foot Evaluation.

Diabetic foot is a well-known complication with considerable morbidity and mortality related to the diabetic population. Neuropathy, deformity, infection and ischemia are important contributors to the pathogenesis of diabetic foot ulcers. A multidisciplinary team approach by physicians, nursing staff, diabetic educators and the caregiver as well as close monitoring of feet by the patient himself can prevent foot-related complications. Proper foot care, foot hygiene, annual foot examination and the correct choice of footwear are the main elements in preventing foot problems like deformity, ulceration and amputations. Physicians play a key role in the early detection and prevention of foot problems. Foot evaluation is the most neglected part of physical examination in diabetic patients. This inertia is evident in both physicians and patients. Emphasis on visual inspection and physical foot examination at every visit may address the morbidity and mortality due to diabetic neuropathy and vasculopathy. This article will highlight extensively history taking and foot examination in the diabetic foot clinic. Optimal glycemic control, simple foot care practices, knowledge and appropriate footwear use play an important role to reduce the disease burden.