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Definition

Virilization is when a female develops male sex characteristics, or a newborn boy has increased male characteristics at birth.

Information

Virilization may be caused by:

In newborn girls, the condition may be caused by:

  • Certain medications taken by the mother during pregnancy
  • Congenital adrenal hyperplasia in the baby or her mother
  • Other medical conditions in the mother (such as tumors of the ovaries or adrenal glands that release male hormones)

Signs of virilization in a female may include:

Tests may include:

  • Blood tests to detect excess testosterone in females
  • CT scan, MRI, or ultrasound to rule out tumors of the ovaries and adrenal glands
References

Stewart PM. The adrenal cortex. In: Kronenberg HM, Shlomo M, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 14.

Styne DM, Grumbach MM. Puberty: ontogeny, neuroendocrinology, physiology, and disorders. In: In: Kronenberg HM, Shlomo M, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 24.

Endocrine Society. Androgen therapy in women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006;91(10):2697-3716.

Parker KL. Sexual Differentiation. In: Griffin JE, Ojeda SR. Textbook of Endocrine Physiology. New York, NY: Oxford University Press; 2004:167-185.

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Definition

Virilization is when a female develops male sex characteristics, or a newborn boy has increased male characteristics at birth.

Information

Virilization may be caused by:

In newborn girls, the condition may be caused by:

  • Certain medications taken by the mother during pregnancy
  • Congenital adrenal hyperplasia in the baby or her mother
  • Other medical conditions in the mother (such as tumors of the ovaries or adrenal glands that release male hormones)

Signs of virilization in a female may include:

Tests may include:

  • Blood tests to detect excess testosterone in females
  • CT scan, MRI, or ultrasound to rule out tumors of the ovaries and adrenal glands
References

Stewart PM. The adrenal cortex. In: Kronenberg HM, Shlomo M, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 14.

Styne DM, Grumbach MM. Puberty: ontogeny, neuroendocrinology, physiology, and disorders. In: In: Kronenberg HM, Shlomo M, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 24.

Endocrine Society. Androgen therapy in women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006;91(10):2697-3716.

Parker KL. Sexual Differentiation. In: Griffin JE, Ojeda SR. Textbook of Endocrine Physiology. New York, NY: Oxford University Press; 2004:167-185.

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Female virilization or female masculization

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Endocrinologists, doctors who specialize in the diagnosis and treatment of glandular disorders, have the most expertise to deal with adrenal virilization. Some doctors who treat disorders of the internal organs (internists)

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Congenital adrenal hyperplasia (CAH) refers to any of several autosomal recessive diseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of cortisol from cholesterol by the adrenal glands (steroidogenesis). Most of these conditions involve excessive or deficient production of sex steroids and can alter development of primary or secondary sex characteristics in some affected infants, children, or adults. Only a small minority of people with CAH can be said to have an intersex condition, but this attracted American public attention in the late 1990s and many accounts of varying accuracy have appeared in the popular media. Approximately 95% of cases of CAH are due to 21-hydroxylase deficiency.

Examples of conditions caused by various forms of CAH: * ambiguous genitalia, in some females, such that it can be initially difficult to determine sex * vomiting due to salt-wasting leading to dehydration and death * early pubic hair and rapid growth in childhood * precocious puberty or failure of puberty to occur (sexual infantilism: absent or delayed puberty) * excessive facial hair, virilization, and/or menstrual irregularity in adolescence * infertility due to anovulation * hypertension

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Definition

Adrenocortical carcinoma is a cancer of the adrenal glands.

Alternative Names

Tumor - adrenal

Causes, incidence, and risk factors

Adrenocortical carcinoma is most common in children younger than 5 and adults in their 30s and 40s.

Adrenocortical carcinoma may be linked to a cancer syndrome that is passed down through families (inherited). Both men and women can develop this tumor. Adrenocortical carcinoma can produce the hormones cortisol, estrogen, or aldosterone. In women the tumor often releases the hormones, which can lead to male characteristics.

The cause is unknown. About 2 people per million develop this type of tumor.

Symptoms

Symptoms that suggest increased cortisol production:

  • Fatty, rounded hump high on the back just below the neck (buffalo hump)
  • Flushed rounded face with pudgy cheeks (moon face )
  • Obesity
  • Stunted growth in height (short stature)
  • Virilization - the appearance of male characteristics, including increased body hair especially on face, pubic hair, acne, deepening of voice, and enlarged clitoris (girls)

Symptoms that suggest increased aldosterone production are the same as symptoms of low potassium and include weakness, muscle cramps, increased thirst, and urination.

Signs and tests

A physical exam reveals high blood pressure. Blood work will be done to check hormone levels:

Imaging tests may include:

Treatment

Primary treatment is surgery to remove the tumor. Adrenocortical carcinoma may not improve with chemotherapy. Medications may be given to reduce production of cortisol, which causes many of the symptoms.

Expectations (prognosis)

The outcome depends on how early the diagnosis is made and whether the tumor has spread (metastasized). Tumors that have spread often lead to death within 1 to 3 years.

Complications

The tumor can spread to the liver, bone, lung, or other areas.

Calling your health care provider

Call your health care provider if you or your child has symptoms of adrenocortical carcinoma, Cushing syndrome, or failure to grow.

References

Lal G, O'Dorisio T, McDougall R, Weigel RJ. Cancer of the endocrine system. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 75.

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