Testosterone exposure in childhood: discerning pathology from physiology

被引:10
作者
Cabrera, Susanne M. [1 ]
Rogol, Alan D. [2 ]
机构
[1] Childrens Hosp Wisconsin, Med Coll Wisconsin, Div Endocrinol, Dept Pediat, Milwaukee, WI 53201 USA
[2] Univ Virginia, Dept Pediat, Charlottesville, VA 22911 USA
关键词
androgen; hyperandrogenism; pediatrics; secondary exposure; testosterone; virilization; CONGENITAL ADRENAL-HYPERPLASIA; POLYCYSTIC-OVARY-SYNDROME; PRECOCIOUS PUBERTY SECONDARY; SEX-DETERMINING REGION; GROWTH-HORMONE; AROMATASE DEFICIENCY; TURNERS-SYNDROME; ANDROGEN EXCESS; FINAL HEIGHT; HYPERGONADOTROPIC HYPOGONADISM;
D O I
10.1517/14740338.2013.782000
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Introduction: Testosterone (T) drives normal male sexual development both in utero and at puberty. Aberrant T exposure manifests as virilization of a female fetus, contrasexual precocity in girls, and isosexual precocity in boys. Evidence of pathologic T exposure warrants a prompt evaluation. Areas covered: The authors introduce the topic of T exposure in children by reviewing its physiology in the fetus and during childhood and adolescence. Pathologic conditions leading to virilization of a female fetus as well as androgen-mediated gonadotropin-independent precocious puberty in both genders are then discussed. The authors finish by noting exogenous T exposure in children and adolescents, focusing specifically on secondary exposure to topical T preparations. Expert opinion: Contrasexual precocity in a girl or sexual precocity in a boy should prompt evaluation for causes of gonadotropin-independent pubertal changes. Initial biochemical evaluation includes a bone age, T, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone sulfate (DHEA-S) and high sensitivity gonadotropin levels. The provider must query exposure to topical androgen-containing preparations as unintentional secondary exposure to topical T must be considered. Hyperandrogenism is temporally related to exposure of topical T and removal of exposure results in a marked decrease in serum T as well as resolution or stabilization of the signs and symptoms.
引用
收藏
页码:375 / 388
页数:14
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