Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil,
Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Horm Res Paediatr. 2019;91(6):411-415. doi: 10.1159/000495664. Epub 2019 Jan 24.
BACKGROUND/AIMS: Premature pubarche is associated with conditions such as virilizing congenital adrenal hyperplasia, androgen-secreting tumors, and exogenous exposure to androgen products. We describe the clinical and hormonal features of a series of children who were referred to endocrine evaluation due to premature pubarche.
This is a retrospective case series study of 14 children with premature pubarche and/or virilization. Five were unintentionally exposed to testosterone gel (parental use). Nine patients were intensely exposed to diaper rash prevention creams. Clinical and laboratory data were revised.
Moderate to severe virilization was detected in the 5 patients (2 boys and 3 girls) who were exposed to testosterone gel. These patients had pubic hair development associated with clitoromegaly (3/3), penile enlargement (2/2), and accelerated growth (5/5). Testosterone levels were elevated in 4/5 patients associated with normal prepubertal gonadotropin levels and adrenal androgen precursors. The 9 children who were intensely exposed to diaper rash prevention creams had mild pubarche (intermediate hair) without any other clinical manifestation of pubertal development. Three of them exhibited pubic hair thinning after cream withdrawal.
Unintentional topical androgen exposure or the intense use of diaper rash prevention cream should be ruled out in children with precocious pubarche and/or virilization signs to avoid misdiagnosis and expendable investigation.
背景/目的：性早熟与促肾上腺皮质激素性肾上腺增生、雄激素分泌肿瘤和雄激素产品的外源性暴露等疾病有关。我们描述了因性早熟而接受内分泌评估的一系列儿童的临床和激素特征。
这是一项回顾性病例系列研究，纳入了 14 例性早熟和/或性发育过早的儿童。其中 5 例因意外接触睾酮凝胶（父母使用），9 例因强烈接触尿布疹预防乳膏。对临床和实验室数据进行了回顾。
5 例（2 男 3 女）接触睾酮凝胶的患者出现中度至重度性早熟。这些患者的阴毛发育与阴蒂肥大（3/3）、阴茎增大（2/2）和生长加速（5/5）相关。4/5 的患者睾酮水平升高，同时伴有正常的青春期前促性腺激素水平和肾上腺雄激素前体。9 例强烈接触尿布疹预防乳膏的儿童出现轻度性早熟（中间毛发），没有任何其他青春期发育的临床表现。其中 3 例在停用乳膏后出现阴毛稀疏。
对于出现性早熟和/或性早熟迹象的儿童，应排除意外局部雄激素暴露或强烈使用尿布疹预防乳膏，以避免误诊和不必要的检查。
