NONADRENAL FEMALE PSEUDOHERMAPHRODISM AFTER ADMINISTRATION OF TESTOSTERONE TO MOTHER DURING PREGNANCY

Abstract
THE DIAGNOSIS of nonadrenal female pseudohermaphrodism should be based on the following criteria: (1) the external genitalia should show hypertrophy of the clitoris and some degree of labial fusion; (2) in infants, measurement of 17-ketosteroids or pregnanetriol should be performed to rule out the adrenogenital syndrome; in older patients this syndrome can be ruled out clinically by the lack of precocious puberty and progressive masculinization; (3) laparotomy should reveal a female internal genital apparatus, and (4) adequate biopsies of both gonads should show normal ovaries, excluding the possibility of ovotestes and true hermaphrodism. The subject of pseudohermaphrodism is adequately covered by Wilkins et al. in a recent article in which 12 cases of nonadrenal female pseudohermaphrodism are mentioned; however, not all of these meet the four conditions described above. There are two in the literature in which pseudohermaphrodism followed the occurrence of masculinizing tumors (arrhenoblastoma) during pregnancy, but no mention was found of a case in which testosterone had been administered to the mother. CASE REPORT History This infant was the first born of a 28-year-old white woman who consulted her obstetrician because of nausea and vomiting 10 weeks after the onset of the last menstrual period. On that day 100 mg of testosterone propionate was administered intramuscularly, and 10 mg of methyl testosterone three times a day was prescribed. Three days later another 100 mg of testosterone propionate was administered. She had taken 30 mg of testosterone by mouth daily for 51 days when administration was discontinued because of deepening voice.