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is a significant concern for physicians. Central" \" l6 G% S) J; i" j- l
precocious puberty (CPP), which is mediated- q2 D' M1 O. Z& z* R' t! h
through the hypothalamic pituitary gonadal axis, has$ A' t- V2 {) _$ z7 B- u* N2 [
a higher incidence of organic central nervous system
5 g& _3 ^: W* B/ `% h/ ^1 }lesions in boys.1,2 Virilization in boys, as manifested! y* f* M6 w4 F
by enlargement of the penis, development of pubic
; s9 p. j( z% d: g, s( ]hair, and facial acne without enlargement of testi-
( I9 a: z% p, n  I! Icles, suggests peripheral or pseudopuberty.1-3 We6 H' l# v- u; T2 `. b! z. |
report a 16-month-old boy who presented with the
  f! q: k6 E+ }, M) Penlargement of the phallus and pubic hair develop-! D7 i1 O1 h* k9 T
ment without testicular enlargement, which was due9 }+ |' ]# J) m5 C* L6 S
to the unintentional exposure to androgen gel used by; T. j" _! @1 M9 Z; |9 K0 E
the father. The family initially concealed this infor-
# u0 E( l2 p: {2 }mation, resulting in an extensive work-up for this
' F' m0 }8 R# b4 K9 ychild. Given the widespread and easy availability of
/ P+ ^9 c3 N8 w$ F1 p8 P6 p2 N: P# Y2 Ntestosterone gel and cream, we believe this is proba-, o3 I% i4 W4 f0 v4 a! }" z, H% i
bly more common than the rare case report in the4 `5 z" y$ e: r% M( X3 }
literature.4
+ a$ m0 f* a1 g7 _4 r! o2 J: nPatient Report
) a( p3 X8 d1 K8 ?* N6 z0 [: PA 16-month-old white child was referred to the
+ i. x4 ]* c+ q7 _9 p8 P) lendocrine clinic by his pediatrician with the concern3 m$ }" u/ ~) A. G- z. Z
of early sexual development. His mother noticed. H( W. i; U( p7 f
light colored pubic hair development when he was* E$ Y: c6 c7 ]; ~! T. H. L
From the 1Division of Pediatric Endocrinology, 2University of, r4 N, H/ U! W/ }! H& Q% G! V! r
South Alabama Medical Center, Mobile, Alabama.
5 ~9 K7 e1 X+ N8 g, ]4 g! |& v4 oAddress correspondence to: Samar K. Bhowmick, MD, FACE,  V# _: q0 S( V+ j% A/ r+ |
Professor of Pediatrics, University of South Alabama, College of
# m% |1 b6 ^6 |6 YMedicine, 2451 Fillingim St. Mastin 212, Mobile, AL 36617-2297;8 ]' e; P) m( v: \, s
e-mail: [email protected].
) s8 Q. d' S) W3 X, o% E& S% xabout 6 to 7 months old, which progressively became4 {- ?/ L. w6 i0 m/ b& s/ F6 R  \
darker. She was also concerned about the enlarge-
; L- m9 V; s/ q' @ment of his penis and frequent erections. The child& n& @* n* o$ ^& a$ `" e
was the product of a full-term normal delivery, with
- O* W1 z( U% |- fa birth weight of 7 lb 14 oz, and birth length of9 l+ X  B' ^0 w. g/ ~+ V
20 inches. He was breast-fed throughout the first year
' O3 a$ a% [: s& y% {of life and was still receiving breast milk along with
! k$ E( f# n) _1 U( k1 Tsolid food. He had no hospitalizations or surgery,0 C0 M/ A  B- b& Z* ]% Q1 \6 e. D" \
and his psychosocial and psychomotor development& _8 r9 {, h. X' G0 G* M
was age appropriate.
8 Q0 U. x4 J0 u* ]2 H& v( V* VThe family history was remarkable for the father,
) N' c2 I7 P: }1 E6 lwho was diagnosed with hypothyroidism at age 16,
" T7 g) l- H6 n. [# `, J' [which was treated with thyroxine. The father’s
) T6 i) n  F. @height was 6 feet, and he went through a somewhat
6 E7 _  m* Y2 p' r) J9 A# xearly puberty and had stopped growing by age 14.4 \0 Q4 a7 ]* @# F$ E0 e: a
The father denied taking any other medication. The' k7 _; ]1 a# L
child’s mother was in good health. Her menarche
. ?+ C! V- s% j5 u0 |was at 11 years of age, and her height was at 5 feet: C* s! f3 L5 O7 Z) C0 s4 c! l
5 inches. There was no other family history of pre-
+ \6 o- B) w7 y' F, kcocious sexual development in the first-degree rela-3 [' u& z; f+ O  d: y1 p
tives. There were no siblings.
) [/ H# o  W! D& [Physical Examination9 X3 A) W( c1 I! T. }
The physical examination revealed a very active,
1 ]+ b, B9 Y& U# S7 wplayful, and healthy boy. The vital signs documented' Z6 k# c3 X0 x& x) d) `2 u
a blood pressure of 85/50 mm Hg, his length was
! L+ r/ Y8 T" S4 _. J# }90 cm (>97th percentile), and his weight was 14.4 kg
* R! d7 b( c* l1 ]: v/ I5 I; F(also >97th percentile). The observed yearly growth& G7 j3 p: R7 K; x0 G/ t
velocity was 30 cm (12 inches). The examination of2 l6 g4 N# \0 D, p8 i: |
the neck revealed no thyroid enlargement.
. V0 ~5 O9 c8 j$ f3 c: _The genitourinary examination was remarkable for
! H3 Q- t* Y. uenlargement of the penis, with a stretched length of7 k( i0 t+ p/ z$ R) W. f% l
8 cm and a width of 2 cm. The glans penis was very well
2 y- ^- b( G, B! r# o2 n9 T% ydeveloped. The pubic hair was Tanner II, mostly around
6 P! y9 n/ H0 P* c- p; t8 ^7 @0 z# i540
2 |" ^! \  L  D  X' J1 _5 }, Bat University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from, R7 d6 n' V- k- o) ]
the base of the phallus and was dark and curled. The
. Y1 n# `8 r6 |" z% P( Ftesticular volume was prepubertal at 2 mL each.& Z. X) s. T/ Z
The skin was moist and smooth and somewhat( o5 v# P+ F# v5 b' o) o8 F
oily. No axillary hair was noted. There were no1 V8 l& ]. A% b, I, Q: I
abnormal skin pigmentations or café-au-lait spots.
: [) H% \1 a* oNeurologic evaluation showed deep tendon reflex 2+
, J8 ^7 f, g0 a. R  m4 Q5 ]bilateral and symmetrical. There was no suggestion9 s8 h: M9 l, y8 ]: v& u
of papilledema.% k' \6 z) U1 I
Laboratory Evaluation! B. p$ e3 x: w. W# w
The bone age was consistent with 28 months by
# H/ U$ M# w) ^5 d7 d' \# {% Gusing the standard of Greulich and Pyle at a chrono-5 ?. ?0 v9 \: c5 b2 B4 V9 ?; `' j( G2 {3 S
logic age of 16 months (advanced).5 Chromosomal0 d, {$ M9 h* \5 `, i
karyotype was 46XY. The thyroid function test
3 A4 K" z6 c, b* Eshowed a free T4 of 1.69 ng/dL, and thyroid stimu-+ m* R& u8 d3 ]4 \8 j$ S- i
lating hormone level was 1.3 µIU/mL (both normal).0 K. X+ B- z2 F" ~! r' ?
The concentrations of serum electrolytes, blood
1 D6 j; j. y/ o3 Z3 `urea nitrogen, creatinine, and calcium all were
0 p( z  U. i5 X. L  C' B  G& j+ hwithin normal range for his age. The concentration
0 J5 k, `( v7 R% R' p: K% p! Dof serum 17-hydroxyprogesterone was 16 ng/dL
% \" }. U: I, K  \& a  \(normal, 3 to 90 ng/dL), androstenedione was 20
$ u; w& _- `. B- Vng/dL (normal, 18 to 80 ng/dL), dehydroepiandros-/ {7 R2 g. J0 v2 V+ H0 M9 z1 V
terone was 38 ng/dL (normal, 50 to 760 ng/dL),# J& H+ d' y; I* d: W, X  y
desoxycorticosterone was 4.3 ng/dL (normal, 7 to
( y9 r. U8 @1 C+ O6 E5 }3 [49ng/dL), 11-desoxycortisol (specific compound S)3 j: F) a# @% ^: p+ @
was 43 ng/dL (normal, 10 to 156 ng/dL), serum cor-; b% I' S# `& Q. y, _  [9 j
tisol was 7.6 µg/dL (normal, 2.8 to 23 µg/dL), total4 \4 E- \' p8 E9 W4 H% r9 h2 @
testosterone was 60 ng/dL (normal <3 to 10 ng/dL),6 l) N/ x. n+ @0 y5 j6 V
and β-human chorionic gonadotropin was less than% |6 O/ d8 A  I' T
5 mIU/mL (normal <5 mIU/mL). Serum follicular
: _5 q* T" t0 h4 X2 r' ]2 `0 S" s! Mstimulating hormone and leuteinizing hormone
* A+ O9 l6 u  J, ^" V% Oconcentrations were less than 0.05 mIU/mL
, W1 m1 l( M: u! \3 T) t. U(prepubertal)./ f( s8 c% Y8 O
The parents were notified about the laboratory
; H1 U" E! l5 U+ n+ X) M9 j7 hresults and were informed that all of the tests were$ z9 ~8 H) M: s  d
normal except the testosterone level was high. The
# v3 ^* l# `% l  jfollow-up visit was arranged within a few weeks to
" \8 y0 f; x: i" Nobtain testicular and abdominal sonograms; how-
. i. v" I" [- `' @8 X0 _( qever, the family did not return for 4 months., r7 U( Z& E+ c+ l6 N
Physical examination at this time revealed that the$ l+ {" z0 T5 O# e( ^
child had grown 2.5 cm in 4 months and had gained
$ A, J7 K" o% @2 kg of weight. Physical examination remained1 O# D8 [9 J/ P( w  Z* H) r7 I" a5 F
unchanged. Surprisingly, the pubic hair almost com-! O9 _! n" k- ]+ d
pletely disappeared except for a few vellous hairs at
) z: R+ |  E7 b  Fthe base of the phallus. Testicular volume was still 2
$ M! h# B3 k. {5 j# m/ u( B" Q# hmL, and the size of the penis remained unchanged.
3 d7 u- Z9 O' G5 s* g  g5 KThe mother also said that the boy was no longer hav-5 C( [/ X  @. u
ing frequent erections.
* v% ?8 ~2 _  c. a3 S) ]Both parents were again questioned about use of
9 Z9 J" {. k1 O, Y3 H7 t, y) @4 Jany ointment/creams that they may have applied to
6 ^! a; m) d) N. tthe child’s skin. This time the father admitted the1 b% ?; ^' Y% M0 M
Topical Testosterone Exposure / Bhowmick et al 5412 I8 g1 I6 ]0 K% L
use of testosterone gel twice daily that he was apply-
2 U7 M$ m4 `' @( T: ting over his own shoulders, chest, and back area for1 ]8 X0 y  G8 ^1 `  `' ^8 F2 E7 I
a year. The father also revealed he was embarrassed- g  J5 h# ^8 r7 ~
to disclose that he was using a testosterone gel pre-
0 q, H: Q* x5 V. m$ Q. [scribed by his family physician for decreased libido1 L2 D4 @" _6 P$ {2 `8 O9 n1 N  J2 t
secondary to depression.
. F( b7 A8 W- \: \* @6 u! V" H1 IThe child slept in the same bed with parents.
8 y& s# a0 {' F$ bThe father would hug the baby and hold him on his& A! m; @5 E' {. U7 Z& B7 E
chest for a considerable period of time, causing sig-
" D$ Q& U5 p4 @( h! Qnificant bare skin contact between baby and father.  z: P% S% t) ^
The father also admitted that after the phone call," F% a( x( L" u
when he learned the testosterone level in the baby) e* _) ]# C4 F, m9 F4 u. ?% I* U4 W8 d  I
was high, he then read the product information' b5 Y) h* {7 j- \6 W) x3 u& `) y7 V* X
packet and concluded that it was most likely the rea-6 W5 [( B$ Z3 f8 R1 I' p8 i
son for the child’s virilization. At that time, they! M4 P/ ~$ E( |) ~- {3 A; I7 c
decided to put the baby in a separate bed, and the% {5 R& B" K  N% h+ ~
father was not hugging him with bare skin and had
/ Q* Y) ]/ e+ U% y3 M+ A) q0 m) [been using protective clothing. A repeat testosterone
+ ]& g; X5 }& x- v1 y  K/ Stest was ordered, but the family did not go to the
# X2 @# ]% ?! M. c+ Rlaboratory to obtain the test.
# w0 ]" a0 [+ X- L& ]" {+ qDiscussion# i/ t0 t8 x1 y3 i' g- V& Z! O
Precocious puberty in boys is defined as secondary; I8 i: W$ C) Q# v* v4 i7 l) _$ M
sexual development before 9 years of age.1,4) M: ~9 c8 B3 ~3 X) u8 v/ W# q
Precocious puberty is termed as central (true) when
% F2 c6 G! d$ C- U9 Lit is caused by the premature activation of hypo-* r4 |% i' V7 y! G9 F; |
thalamic pituitary gonadal axis. CPP is more com-
" d7 C+ m5 y2 K3 H. @1 C  \1 g2 Pmon in girls than in boys.1,3 Most boys with CPP0 W+ S2 V) v) `* }
may have a central nervous system lesion that is
  b$ x7 C4 `" n  eresponsible for the early activation of the hypothal-4 p- m' F' U% F0 e, U3 K0 p9 z
amic pituitary gonadal axis.1-3 Thus, greater empha-! k3 y* d) F- |0 z  e: Q1 ]: Z
sis has been given to neuroradiologic imaging in
) c* N% }' \0 S# k, B5 i2 [, u1 Dboys with precocious puberty. In addition to viril-; v6 B* i, o6 F1 f) _: ~: e/ B: c' X
ization, the clinical hallmark of CPP is the symmet-
9 c/ A, \+ V7 u& V6 w  Frical testicular growth secondary to stimulation by4 C; m; L+ l  V; _: h' B2 Y' N" @3 h
gonadotropins.1,35 J' ~" X6 d* j8 v6 M
Gonadotropin-independent peripheral preco-* {2 C. N) l/ B3 F
cious puberty in boys also results from inappropriate; s% J6 {% K0 Z9 j5 I: p1 i, i
androgenic stimulation from either endogenous or2 o# G8 _) ^1 |; E) j/ E
exogenous sources, nonpituitary gonadotropin stim-
6 A/ O( t( T. N) e$ X) Q8 h" H# d8 eulation, and rare activating mutations.3 Virilizing
# T; v+ Z* b" s! Kcongenital adrenal hyperplasia producing excessive
* [3 T1 u2 J) f# h, ~  w: kadrenal androgens is a common cause of precocious6 J, w$ n" c  H* N
puberty in boys.3,4
' M9 p7 w, T  m7 VThe most common form of congenital adrenal0 o8 m; H& T7 r$ m$ E, g. o) ~
hyperplasia is the 21-hydroxylase enzyme deficiency.
5 p6 q7 C3 d8 I* c" qThe 11-β hydroxylase deficiency may also result in
5 V/ w( @9 E2 y4 `6 O- X/ @excessive adrenal androgen production, and rarely,
3 w/ T+ R' B- E" ~7 R# qan adrenal tumor may also cause adrenal androgen3 u9 F' B$ l* F$ s7 E
excess.1,3
( z5 Y# d. w8 a: Nat University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from" A( A2 |: i! R" |( Y0 Y" v2 L
542 Clinical Pediatrics / Vol. 46, No. 6, July 2007
; E! z. M2 V6 }A unique entity of male-limited gonadotropin-! C+ ~. f: A- K3 u5 B* t. W% F
independent precocious puberty, which is also known
. ]  |- P$ L* `( z. ^, p6 {# _0 J6 Das testotoxicosis, may cause precocious puberty at a7 U7 t& y: R' H4 y
very young age. The physical findings in these boys
: G9 C4 J: O# n/ c# pwith this disorder are full pubertal development,
; M  U# p2 y/ x( S3 q* H  q$ xincluding bilateral testicular growth, similar to boys1 G) A! `' H8 ^9 d9 {# y' O
with CPP. The gonadotropin levels in this disorder" {/ ~7 h4 i1 J# [$ j+ f1 B
are suppressed to prepubertal levels and do not show% `) E! @, O- p" }  \
pubertal response of gonadotropin after gonadotropin-
, `) N( R) h/ f* {# F# K: w2 _releasing hormone stimulation. This is a sex-linked
$ i- y  Z4 W; ]autosomal dominant disorder that affects only  T: e" V& [: e$ U$ P+ \& H& e
males; therefore, other male members of the family: d# x# _( l1 m. ~' R
may have similar precocious puberty.3
9 K% X0 ~3 p9 T4 xIn our patient, physical examination was incon-- L2 ?0 `# V8 v# C9 [
sistent with true precocious puberty since his testi-
7 j5 Q5 T3 K: I: |8 vcles were prepubertal in size. However, testotoxicosis7 I) [, @" }* k( x( N  `
was in the differential diagnosis because his father$ R, l5 v8 A# H: B8 q( R
started puberty somewhat early, and occasionally,
$ D3 \. E3 \# M3 ?testicular enlargement is not that evident in the$ F3 s: E6 v. b! D& y
beginning of this process.1 In the absence of a neg-
1 _7 C  q2 ^$ X5 @. _9 f5 Cative initial history of androgen exposure, our
( {% F( |, M3 ]  N- V! k) }biggest concern was virilizing adrenal hyperplasia,
3 z8 m: J4 E/ v3 p# ]. ceither 21-hydroxylase deficiency or 11-β hydroxylase3 g6 j/ W) w1 I
deficiency. Those diagnoses were excluded by find-
0 q5 H: ~% {8 D. k' F: V8 \$ ding the normal level of adrenal steroids.
; `* |4 S5 G: |' r* w4 n7 ]) Q1 XThe diagnosis of exogenous androgens was strongly/ {" ^% c2 w) M: e' R' M. n2 ~
suspected in a follow-up visit after 4 months because- l! i1 g' u5 K9 c) U
the physical examination revealed the complete disap-- _( J. w: y3 V9 E; s
pearance of pubic hair, normal growth velocity, and9 i) Y" B( G8 d* }. @% x& w+ ^) Z
decreased erections. The father admitted using a testos-
! [8 [* w) Q6 p/ R. B0 |# m  z; |terone gel, which he concealed at first visit. He was5 V+ I% |6 p" W) ~
using it rather frequently, twice a day. The Physicians’
+ u' p% E' F1 {# C  c# f. u( i6 EDesk Reference, or package insert of this product, gel or
& a$ r, c/ ?; y/ Tcream, cautions about dermal testosterone transfer to/ o  p/ b( @' v- M2 a
unprotected females through direct skin exposure.- I1 Z. m/ u) z9 |6 _8 |
Serum testosterone level was found to be 2 times the- F( Q7 k1 R. G. A
baseline value in those females who were exposed to8 x/ ~9 ?) F5 {) ?
even 15 minutes of direct skin contact with their male
0 d. J9 y) Q8 ypartners.6 However, when a shirt covered the applica-: N; p6 k- {( [8 q& g, f( ?
tion site, this testosterone transfer was prevented.# |! g' K, j! [
Our patient’s testosterone level was 60 ng/mL,. G4 \! S8 k  O
which was clearly high. Some studies suggest that
7 ~+ k7 W6 r3 ^( ~dermal conversion of testosterone to dihydrotestos-
; E' s8 N( v' L! x- k' i4 jterone, which is a more potent metabolite, is more$ ~# T6 g" r$ f. D7 ]" R& t/ [" p
active in young children exposed to testosterone
: Z& ^) ?* W/ Q3 J5 r/ mexogenously7; however, we did not measure a dihy-
7 Q: Z) ?. ~2 g7 b! H( _: zdrotestosterone level in our patient. In addition to/ `- k4 f. E0 ]
virilization, exposure to exogenous testosterone in
, I) {! B- \# g# @) dchildren results in an increase in growth velocity and3 ^' `$ d) H2 n3 p$ A" R
advanced bone age, as seen in our patient.
9 n3 `8 `+ d% I& A: ~( }+ uThe long-term effect of androgen exposure during
; F# `  W( `1 a8 q6 W* B) G: @& _early childhood on pubertal development and final6 H; O* [6 V) p' o
adult height are not fully known and always remain: }$ Z8 M/ n/ e( ^1 M4 c4 a
a concern. Children treated with short-term testos-
6 `+ \' u* c! H; g  G* K, Rterone injection or topical androgen may exhibit some
6 W8 u) M: R4 Bacceleration of the skeletal maturation; however, after! z6 X" Y6 Q5 d# z$ R2 k
cessation of treatment, the rate of bone maturation
! H4 x" m+ L9 ~* y, M9 U) Ydecelerates and gradually returns to normal.8,9: s' d7 u/ R! r' Y2 e) v
There are conflicting reports and controversy
0 S4 _- c  F0 Z3 H! |over the effect of early androgen exposure on adult! A3 y4 o9 X1 k) k: e: t2 J# ?
penile length.10,11 Some reports suggest subnormal
, Q/ x% O" X9 M" T. t/ ~) [adult penile length, apparently because of downreg-$ v# T, I' R  q( r! K# q
ulation of androgen receptor number.10,12 However,. j" d/ M- H) |1 g% S9 y$ b
Sutherland et al13 did not find a correlation between
# x( h4 W6 j$ j8 J  ochildhood testosterone exposure and reduced adult
/ t  C# s$ Y  i' X* Qpenile length in clinical studies.
1 H- l/ A; p, y4 c6 b9 @: MNonetheless, we do not believe our patient is
# l; M  _) \  Tgoing to experience any of the untoward effects from
1 f  u# |5 F1 z6 T% f' G" a, Ttestosterone exposure as mentioned earlier because
8 |$ X, b" Q8 S# W9 Uthe exposure was not for a prolonged period of time.' q2 Y7 X+ B2 y/ e
Although the bone age was advanced at the time of" m7 r' n% Q" y4 [! E. V( a4 I. x' _
diagnosis, the child had a normal growth velocity at5 B( ^! i; m. ?( M. d! K0 N
the follow-up visit. It is hoped that his final adult
: T7 u* g! y: w/ theight will not be affected.
) t/ i/ P9 x% U4 RAlthough rarely reported, the widespread avail-
5 }: Y7 t1 Z5 A: D2 B4 dability of androgen products in our society may
! G. ^* o, |( `3 Vindeed cause more virilization in male or female
$ {4 \5 {  |) K+ w% Q2 W1 L& I6 [+ Jchildren than one would realize. Exposure to andro-
  l# E% i7 J  p) \$ {0 N# c4 hgen products must be considered and specific ques-' P  O9 I6 T$ S
tioning about the use of a testosterone product or
1 b. [! `1 f- L! Kgel should be asked of the family members during7 s% S9 H4 \* v# j5 l& ~
the evaluation of any children who present with vir-
2 H# S" O$ Y$ A4 y9 H% p) @- }/ Milization or peripheral precocious puberty. The diag-
. Y2 ]" o8 `3 [7 Cnosis can be established by just a few tests and by0 T4 e) K; d5 U0 g2 z
appropriate history. The inability to obtain such a! Q5 A% f3 _  _
history, or failure to ask the specific questions, may& v6 U% y& I) \
result in extensive, unnecessary, and expensive+ K% j# e0 O! Q) _# b7 Q
investigation. The primary care physician should be, d7 Z& s/ s$ ^; x8 n# a
aware of this fact, because most of these children- K( O: S0 T* n. ?6 k+ C
may initially present in their practice. The Physicians’/ b, u0 q& p+ H) n6 T/ W
Desk Reference and package insert should also put a. L9 J) z9 `( w2 _: J$ f- S7 h
warning about the virilizing effect on a male or
5 \3 T, \  c0 H% G8 `! n  afemale child who might come in contact with some-
7 \7 j! D4 _' A9 N! \; @one using any of these products.
5 |3 |: Y- Y6 MReferences% k% n; L$ c+ @; O
1. Styne DM. The testes: disorder of sexual differentiation  e$ C# ~4 i& C1 v. L
and puberty in the male. In: Sperling MA, ed. Pediatric0 T9 o- U, ~- f' j5 ~: i
Endocrinology. 2nd ed. Philadelphia, PA: WB Saunders;7 d! T3 [% [9 Q5 d5 H
2002: 565-628.- F$ N( W4 Y& O, v5 e
2. Rivarola M, Belgorosky A, Mendilaharzu H, et al. Precocious
8 C, ^; Q, H1 N( Cpuberty in children with tumours of the suprasellar pineal$ w" P6 _" J9 @& S$ z5 D
at University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from
6 ?; H7 v6 t- G/ n7 dTopical Testosterone Exposure / Bhowmick et al 543. u0 @) s) R+ d' D& w
areas: organic central precocious puberty. Acta Paediatr.
! {3 ?  d% m2 R2001;90:751-756.
# J" l9 [) F$ C4 V. `6 `) b; Q3. Lee PA. Puberty and its disorders. In: Lifshitz F, ed.
5 }5 y/ N0 }$ h9 LPediatric Endocrinology. 4th ed. New York, NY: Marcel! i  J" H$ L& Z
Dekker Inc; 2003:211-238.7 T/ n0 X& o! d
4. Yu YM, Punyasavatsu N, Elder D, D’Ercole AJ. Sexual. U3 |) Z, w) G1 A: I
development in a two-year-old boy induced by topical8 `" m( l0 K3 p$ z7 Z
exposure to testosterone. Pediatrics. 1999;104:e23.) R3 x- M; }+ P) ~/ N& p
5. Greulich WW, Pyle SI, eds. Radiographic Atlas of. u9 K+ d  t* T2 D
Skeletal Development of the Hand and Wrist. 2nd ed.
8 M( J5 K( b1 z( XStanford, CA: Stanford University Press; 1959.9 w3 n9 m" I7 C. n  E1 o% h5 ^
6. Physicians’ Desk Reference. Androgel 1% testosterone,- B2 ^$ r3 q9 x
Unimed Pharmaceutical Inc. Montvale, NJ: Medical, t1 k# _6 s( ^; T; R  F
Economics Company, Inc; 2004:3239-3241.
# E6 h. ~) ?( }- o7. Klugo RC, Cerny JC. Response of micropenis to topical6 l( S+ z  G' ?1 C* I
testosterone and gonadotropin. J Urol. 1978;119:
* k7 ^' J0 v+ ^) s, y! u' y667-668." I" e4 N, H* C& k
8. Guthrie RD, Smith DW, Graham CB. Testosterone3 p+ E) L- O! e5 v4 Y
treatment for micropenis during early childhood. J Pediatr.
8 {: a& S" n/ R( U1973;83:247-252.; Y( I& R0 X5 ]. U) G) {: ~
9. Jacobs SC, Kaplan GW, Gittes RF. Topical testosterone
' ?6 |. F8 Z/ D9 Xtherapy for penile growth. Urol. 1975;6:708-710.
7 b5 s: A4 Q3 X6 h10. Husmann DA, Cain MP. Microphallus: eventual phallic% Q9 y1 u# N2 _7 Z
size is dependent on the timing of androgen administra-9 v2 {& y+ a0 U9 A( P4 v+ P
tion. J Urol. 1994;152:734-739.
2 v- S- H- o( Z' R11. McMahon DR, Kramer SA, Husmann DA. Micropenis:! ~7 u" g( n) Q; r. r/ Y$ b
does early treatment with testosterone do more harm
' A8 a1 j: W* S9 r& \than good? J Urol. 1995;154:825-829.6 j- P8 J4 o  D5 H6 g5 u8 ^
12. Takane KK, George FW, Wilson JD. Androgen receptor
' B! h4 W2 @; E) |of rat penis is down-regulated by androgen. Am J Physiol.
. b, C% ^: }* V8 Z8 x7 B# {7 |1990;258:E46-E50.
2 I. k6 s5 c, W( i13. Sutherland RS, Kogan BA, Baskin LS, et al. The effect: d  C8 J2 R4 M, X4 l% |
of prepubertal androgen exposure on adult penile- p* b, C# ~" j( Y5 B+ w2 |
length. J Urol. 1996;156:783-787.
發表於 2025-1-4 13:25:11 | 顯示全部樓層
絕對的好貼!謝謝啊!逐字逐圖地看完這個帖子以後,我的心久久不能平靜,感恩啊!
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這個我收藏了!謝謝分享!WK的資源越來越豐富,這少不了大大的辛勞!
發表於 2025-1-27 16:30:49 | 顯示全部樓層
這個我收藏了!謝謝分享!WK的資源越來越豐富,這少不了大大的辛勞!
發表於 2025-1-29 20:38:58 | 顯示全部樓層
感谢楼主无私分享
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