Virilizations, are they always adrenal hyperplasias or tumors?

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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e10" "paginaFinal" => "e11" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Belén Ariza Jiménez, Beatriz Martin Tejedor, Juan Pedro Lopez-Siguero" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Ana Belén" "apellidos" => "Ariza Jiménez" "email" => array:1 [ 0 => "micodemas@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Martin Tejedor" ] 2 => array:2 [ "nombre" => "Juan Pedro" "apellidos" => "Lopez-Siguero" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "UGC Pediatría, Sección Endocrinología Infantil, Hospital Regional Universitario Materno-Infantil, Málaga, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Virilizaciones, ¿son siempre hiperplasias suprarrenales o tumores?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1041 "Ancho" => 900 "Tamanyo" => 63311 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0100" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Enlarged clitoris measuring 30×10mm." ] ] ] "textoCompleto" => "The diagnosis of acquired disorders of sex differentiation requires a thorough history-taking and examination.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a>A girl aged 3 years presented for assessment of clitoral enlargement and swelling and darkening of the labia majora with onset one month prior (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The physical examination of the labia majora revealed a shape resembling a scrotum, mild pigmentation and posterior synechiae. The clitoris measured 30×10mm, had an erythematous appearance and seemed tender on palpation. There were no palpable inguinal masses nor pubic hair.The abdominal ultrasound showed a prepubertal uterus and small ovaries.Laboratory tests found normal levels of 17-hydroxyprogesterone, dehydroepiandrosterone sulphate and gonadotropins, with elevation of testosterone (3.73ng/mL; normal range, 0.02–0.1ng/mL) that had decreased at 4 days (0.66ng/mL). Both samples had been analysed by tandem mass spectrometry, evincing significant elevation (0.95ng/mL) and the subsequent descent (0.25ng/mL). One month later, her level of testosterone was 0.03ng/mL and the clitoris was less enlarged, measuring 27×10mm.Privately, the father reported he had been in treatment with topical testosterone for erectile dysfunction starting a month before and that he coslept with the patient. The patient’s symptoms had started at the same time as the paternal treatment. Therefore, the patient received a diagnosis of clitoromegaly secondary to exogenous androgen exposure. The patient remained in follow-up to monitor the resolution of enlargement, with a favourable outcome and normalization of testosterone levels after avoiding cosleeping.In cases of virilization or pseudo-precocious puberty, an exogenous drug-induced cause should be suspected,<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a> and avoidance of skin-to-skin contact should be prescribed for the duration of the paternal androgen therapy.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-09-05" "fechaAceptado" => "2021-11-03" "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1041 "Ancho" => 900 "Tamanyo" => 63311 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0100" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Enlarged clitoris measuring 30×10mm." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prenatal virilization associated with paternal testosterone gel therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. 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Stephure" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1515/jpem-2013-0127" "Revista" => array:7 [ "tituloSerie" => "J Pediatr Endocrinol Metab" "fecha" => "2013" "volumen" => "26" "numero" => "9–10" "paginaInicial" => "981" "paginaFinal" => "985" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23729604" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudopubertad precoz tras exposición accidental a testosterona tópica [Precocious pseudopuberty after accidental exposure to topical testosterone]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. López García" 1 => "J.P. López Siguero" 2 => "M.J. Martínez-Aedo Ollero" 3 => "A. Urda Cardona" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2012" "volumen" => "138" "paginaInicial" => "321" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000010000000005/v1_202405192134/S2341287924000735/v1_202405192134/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000010000000005/v1_202405192134/S2341287924000735/v1_202405192134/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287924000735?idApp=UINPBA00005H"]