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Delayed diagnosis and false relapse due to paternal testosterone use in adrenocortical carcinoma.
[cushing syndrome]
The
prognosis
of
pediatric
adrenocortical
carcinoma
often
depends
on
prompt
diagnosis
to
begin
treatment
before
metastatic
progression
.
We
discuss
a
girl
who
presented
at
8
months
of
age
with
virilization
,
which
was
thought
to
be
due
to
exposure
to
a
topical
testosterone
preparation
being
used
by
her
father
.
Her
testosterone
level
did
not
decrease
promptly
after
her
father
discontinued
the
medication
,
however
,
and
when
she
followed
up
with
signs
of
Cushing
syndrome
5
months
later
,
metastatic
adrenocortical
carcinoma
was
diagnosed
.
The
patient
was
successfully
treated
with
surgery
and
multiagent
chemotherapy
.
Nine
months
after
the
end
of
treatment
,
her
testosterone
level
was
again
found
to
be
elevated
.
Testosterone
precursors
were
now
absent
,
however
,
and
there
were
no
imaging
signs
of
recurrence
.
Further
history
showed
that
her
father
had
restarted
topical
testosterone
,
and
this
time
,
exogenous
exposure
was
correctly
diagnosed
.
As
use
of
topical
testosterone
becomes
more
prevalent
,
exogenous
exposure
must
be
considered
in
the
differential
diagnosis
of
childhood
virilization
.
Any
persistent
testosterone
elevation
after
exposure
ceases
or
signs
of
hypercortisolism
,
however
,
are
inconsistent
with
this
diagnosis
.
We
believe
that
the
risk-benefit
ratio
favors
abdominal
ultrasound
to
rule
out
malignancy
in
all
children
presenting
with
virilization
.
Diseases
Validation
Diseases presenting
"metastatic adrenocortical carcinoma"
symptom
cushing syndrome
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