Joyce,
I appreciate that you have asked the question and the parents denied using any preparation containing testosterone, however this does not rule out the possibility completely. Ask if they use any type of topical cream even if it contains herbal medication.
Looking at some of the results in the ppt document, there are two set of results which may be interesting:
1. one with low testosterone and detectable FSH.
• 06/2010 (CA 2 1/2)
– FSH 1.3 U/L ( < 7.0)
– LH 0.3 U/L ( < 5.0)
– E2 < 37 pmol/L ( < 55)
– Testosterone 1.6 nmol/L (< 0.5)
2. one with high tetsosterone and suppressed FSH, hence ? exogenous
• 05/2011 (CA 3 yr 5 mth) – 10:15
– FSH 0.1 U/L
– LH < 0.1 U/L (< 5)
– E2 < 37 pmol/L (< 55)
– Testosterone 8.3 nmol/L (0.3 – 2.5)
If you have any other set of results with testosterone & FSH please post them here.
thanks
Mohammad
Hi Mohammad,
Thanks for your feedback. The parents denied any exogenous testosterone use.
Kind regards,
Joyce
Hi Joyce,
This is really a puzzling case that doesn't follow a known pathophysiology of androgen disorder. The fluctuating testosterone level is unpredictable and unexplainable other than by possible exogenous exposure. Is the father using testogel?
Best regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist
Dear Colleagues,
We have a paediatric endocrine patient at the moment that is puzzling us all. I am posting her details on behalf of the treating endocrinologist in the hope that someone might have more ideas/suggestions on her diagnosis.
The summary is a 4 and a half yr old girl with a 2 year history of progressive pubic hair, growth acceleration, and bone age advancement that is associated with an isolated elevation in testosterone. Karyotype is 46 XX (SRY negative). The unusual biochemical feature is that the DHEAS was not elevated. Urinary steroid profile only showed an elevation in testosterone and its metabolites. Synacthen did not increase the testosterone and dexamethasone did not suppress the testosterone. HCG stimulation resulted in a 3.5 fold increase in androstenedione and testosterone. Imaging studies have not revealed any abnormalities of the ovaries, adrenals or liver. Tumour markers are negative. Laparoscopy revealed normal ovaries. The parents deny exposure to exogenous androgen. (Attached is a PowerPoint if you require more details).
Any ideas would be greatly appreciated.
Thanks.
Kind regards,
Joyce
Joyce Wu
MBBS MAACB FRCPA (Chemical Pathology)
Biochemical Genetics Registrar
Clinical Chemistry
Mater Pathology
Level 6 MAH || Raymond Tce || South Brisbane || Qld 4101
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