WK綜合論壇, WK综合论坛

 找回密碼
 立即注册
樓主: wk007

50000大洋的充氣娃娃,看看我如何跟她做愛[25P]

  [複製鏈接]
累計簽到:24 天
連續簽到:1 天
發表於 2023-11-11 11:17:32 | 顯示全部樓層
VIP精品區,資源無限好賺金任務區,輕松賺金幣
加入VIP,享受高級特權宣傳賺金又升級,超級棒
#在這裡快速回復#新鮮少見的圖,感恩!
累計簽到:5 天
連續簽到:1 天
發表於 2025-1-4 03:38:58 | 顯示全部樓層
VIP精品區,資源無限好賺金任務區,輕松賺金幣
加入VIP,享受高級特權宣傳賺金又升級,超級棒
is a significant concern for physicians. Central
7 l, Y6 t& h* E0 ]( eprecocious puberty (CPP), which is mediated: j, [. b# z4 U9 W& L3 |; @
through the hypothalamic pituitary gonadal axis, has5 S8 w( h# z1 z+ R: L: O
a higher incidence of organic central nervous system
' p( ?" F3 K; q$ Q. y$ ^lesions in boys.1,2 Virilization in boys, as manifested" n6 Q2 N% v7 t9 X2 G) [- b
by enlargement of the penis, development of pubic6 `1 e1 p* i0 Y" l& \9 X; H
hair, and facial acne without enlargement of testi-/ t: D1 l1 Q8 z
cles, suggests peripheral or pseudopuberty.1-3 We) h& v$ _9 k% Z. y# Z( a$ k1 z
report a 16-month-old boy who presented with the- }3 |" \  W8 F& H
enlargement of the phallus and pubic hair develop-, h+ G4 a+ e; J1 ?/ |  I
ment without testicular enlargement, which was due) H3 X9 k8 |% r, Z9 x
to the unintentional exposure to androgen gel used by
& V+ U  A7 a& b( a" H/ L( |/ h* qthe father. The family initially concealed this infor-, a- A7 s4 a  i' X5 E+ K
mation, resulting in an extensive work-up for this
* C+ n. T2 M3 Zchild. Given the widespread and easy availability of* y3 K+ c) d  `( K' b6 q3 i2 p2 |3 V
testosterone gel and cream, we believe this is proba-6 P6 m- K6 s9 a0 x
bly more common than the rare case report in the5 _% Q4 Z) i& D7 a
literature.4+ ?3 M3 {4 _' o8 F8 M; [: G* v: Q1 [
Patient Report: l+ R+ n) [0 `6 Q0 ]) g6 K& P
A 16-month-old white child was referred to the. F( i0 g% `) V" ^2 l% o5 Y( W
endocrine clinic by his pediatrician with the concern) x) L1 a1 R. c7 l# j, T
of early sexual development. His mother noticed* M2 }5 p( X# _" V0 _% `- C
light colored pubic hair development when he was% d1 E) l! e6 U) r! m% J. D
From the 1Division of Pediatric Endocrinology, 2University of
+ x4 z1 }2 L! m; j2 p% LSouth Alabama Medical Center, Mobile, Alabama.
8 p0 Q. l6 e0 M* v" t& DAddress correspondence to: Samar K. Bhowmick, MD, FACE,: l6 B& s2 Y$ i5 e
Professor of Pediatrics, University of South Alabama, College of; D! L( M9 ~) u6 i( K( q
Medicine, 2451 Fillingim St. Mastin 212, Mobile, AL 36617-2297;' l! @5 v8 a. k# E* W, ^* @  J
e-mail: [email protected].) l- b6 G! y, }  M- t& S2 ^) N
about 6 to 7 months old, which progressively became8 e) f& H% D* Q
darker. She was also concerned about the enlarge-
9 p# j0 [& Y  A, d' W+ b! Ament of his penis and frequent erections. The child9 Y" t7 X: N! w/ m) u( C0 h7 @
was the product of a full-term normal delivery, with2 n- j+ {. }0 Y$ I' t
a birth weight of 7 lb 14 oz, and birth length of* B8 q! }+ ?! Q6 ]
20 inches. He was breast-fed throughout the first year7 W' U: j# B0 R- ?, z. j5 f
of life and was still receiving breast milk along with6 e" Q7 i; \3 O  s6 J
solid food. He had no hospitalizations or surgery,3 e. K4 H( T" l/ Z0 i# {* q
and his psychosocial and psychomotor development
4 t/ L# x2 e8 ~+ J7 Q7 L' ~was age appropriate.
! B. q' k1 Y" ^, aThe family history was remarkable for the father,, L7 c* x% d7 e, @) x9 [
who was diagnosed with hypothyroidism at age 16,
+ f' L( O- ]( E* Kwhich was treated with thyroxine. The father’s8 f) z5 y" y; X
height was 6 feet, and he went through a somewhat5 o8 L  G5 ?/ K; B
early puberty and had stopped growing by age 14." O2 h3 A& p% v( j( K+ J& e
The father denied taking any other medication. The
, ?4 F+ q- R% G4 g. Vchild’s mother was in good health. Her menarche
' N8 C) S/ W  B, S/ @& S$ n, t5 Dwas at 11 years of age, and her height was at 5 feet3 H' H- q" ]  @. J
5 inches. There was no other family history of pre-
4 t+ E' q& q( s8 D3 R+ ecocious sexual development in the first-degree rela-0 t3 A: Z  g4 R2 R7 N) p
tives. There were no siblings.0 p1 _/ d% c1 |. _' q
Physical Examination
- Y7 r# Y- J+ F% T, IThe physical examination revealed a very active,
" e4 F* z- e5 @6 N! c1 iplayful, and healthy boy. The vital signs documented
- A" a% w. K# Q( }' Aa blood pressure of 85/50 mm Hg, his length was9 \( M: n6 a  G6 E& f: V
90 cm (>97th percentile), and his weight was 14.4 kg
$ |5 F: }; P  ?8 n# y(also >97th percentile). The observed yearly growth6 Q8 l- y8 _! M
velocity was 30 cm (12 inches). The examination of
! o' S' r' O- X, x) ithe neck revealed no thyroid enlargement.
. g1 I* g# q, bThe genitourinary examination was remarkable for; G- k0 ]" o5 w& x
enlargement of the penis, with a stretched length of: B3 ?" o% D. q6 Z1 _
8 cm and a width of 2 cm. The glans penis was very well
) Z0 _+ T! ~; Y4 d% ^developed. The pubic hair was Tanner II, mostly around2 A6 y+ J; _! n' ]$ c
540
5 H0 P, |7 @! M( jat University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from
/ m( t# S% H. x4 uthe base of the phallus and was dark and curled. The
* e/ R4 m- s* A- s2 ntesticular volume was prepubertal at 2 mL each.
8 u, _* D& g( r& F+ d3 tThe skin was moist and smooth and somewhat
/ k+ E0 F& @: ?, doily. No axillary hair was noted. There were no- Z. j! A( k1 s  a
abnormal skin pigmentations or café-au-lait spots.! q, D6 H* F$ z! M: P; _  G3 u2 D
Neurologic evaluation showed deep tendon reflex 2+" r. j. {' L, V, l# r
bilateral and symmetrical. There was no suggestion
! R1 a) S8 `0 G+ j* q( Vof papilledema.. q4 k2 V$ X# t/ A; C! N
Laboratory Evaluation9 r, v- c9 q5 D  J3 Y7 |' G) G
The bone age was consistent with 28 months by
# w" h2 o3 y& }using the standard of Greulich and Pyle at a chrono-
4 }7 {1 P# j& ?9 e" Dlogic age of 16 months (advanced).5 Chromosomal2 a# x1 e* n: n: l: A
karyotype was 46XY. The thyroid function test. u  T6 W2 w2 u$ b
showed a free T4 of 1.69 ng/dL, and thyroid stimu-7 c" @+ A7 ~" v% I& ^, D
lating hormone level was 1.3 µIU/mL (both normal).
: ?8 ?& y9 o* _9 wThe concentrations of serum electrolytes, blood* L) \3 j6 Z) M6 @! \5 q- p* `" r
urea nitrogen, creatinine, and calcium all were
2 W' q) ]7 i3 x. @4 b' o+ Wwithin normal range for his age. The concentration; q/ J' @( E+ B- x6 I1 X2 E( i
of serum 17-hydroxyprogesterone was 16 ng/dL
4 e, b! h! Z" U  Y, ^(normal, 3 to 90 ng/dL), androstenedione was 20
) ~+ a% O# S# N! t$ Kng/dL (normal, 18 to 80 ng/dL), dehydroepiandros-
7 H$ D! A1 F3 b7 @terone was 38 ng/dL (normal, 50 to 760 ng/dL),. }9 Y  f8 k, d, b4 B$ A
desoxycorticosterone was 4.3 ng/dL (normal, 7 to, S) r) }1 I9 Q* n" K# l
49ng/dL), 11-desoxycortisol (specific compound S)
( C% {1 f9 m  t6 dwas 43 ng/dL (normal, 10 to 156 ng/dL), serum cor-
7 M5 R, U5 P6 i; x6 Etisol was 7.6 µg/dL (normal, 2.8 to 23 µg/dL), total
2 Q$ h% ^0 Y, Q; ktestosterone was 60 ng/dL (normal <3 to 10 ng/dL),2 p3 p1 d" U+ c2 i2 V. x7 t
and β-human chorionic gonadotropin was less than  M/ g0 V& G/ d3 r$ U
5 mIU/mL (normal <5 mIU/mL). Serum follicular
% F1 o1 V. N6 Jstimulating hormone and leuteinizing hormone
* v% m, U- p1 J9 B3 uconcentrations were less than 0.05 mIU/mL! o% k8 @0 p# U  u
(prepubertal).
6 D, Q' `* B4 D9 ~" sThe parents were notified about the laboratory! l. |' J  t: l8 }! B' k
results and were informed that all of the tests were9 s. D$ {- W, F" S$ `# Y/ f( R. `6 k
normal except the testosterone level was high. The
$ p2 u2 [6 G) ~, Kfollow-up visit was arranged within a few weeks to4 B" s9 x, k) J9 D( q
obtain testicular and abdominal sonograms; how-
9 j6 l4 W1 d9 W5 ]ever, the family did not return for 4 months.
! P3 t; s0 u& NPhysical examination at this time revealed that the* z# s; D8 v; x8 ?, V
child had grown 2.5 cm in 4 months and had gained
$ T0 X: q5 W& c( }2 kg of weight. Physical examination remained" U: W/ {, H  c3 i# C8 @6 e6 B
unchanged. Surprisingly, the pubic hair almost com-- ~5 m/ t. H/ l5 a3 L
pletely disappeared except for a few vellous hairs at
" L. S! ~7 A5 E7 n0 V. i; ^2 F* dthe base of the phallus. Testicular volume was still 20 |7 [" ]) n+ `( p1 ~3 F
mL, and the size of the penis remained unchanged., i; @) Y  }: K
The mother also said that the boy was no longer hav-8 c. R( [; O4 n) K* U* D. a
ing frequent erections.
0 {  M  G5 \: \Both parents were again questioned about use of* ~+ Z( Q7 R$ B4 U) W# F
any ointment/creams that they may have applied to
: |; K9 x1 Z6 D( a% V# Xthe child’s skin. This time the father admitted the
6 W5 W9 `4 G6 i5 _Topical Testosterone Exposure / Bhowmick et al 541
6 n& F8 I  ~5 Z) [( o; guse of testosterone gel twice daily that he was apply-
! W  d8 ~" z( D: m2 B; Sing over his own shoulders, chest, and back area for
. u) f: D9 D& j7 V  T' X" L9 Xa year. The father also revealed he was embarrassed6 _9 m7 L2 X2 F4 t) t. L9 X
to disclose that he was using a testosterone gel pre-7 [3 \8 \6 i5 ~" l# v+ r, g3 x+ M9 a
scribed by his family physician for decreased libido
' |8 M6 ~" ~7 O1 Isecondary to depression.  W) h$ e( z0 @+ D  d
The child slept in the same bed with parents.2 R1 Q" V8 r% @0 {9 Y7 C
The father would hug the baby and hold him on his
' ^# g8 L5 {! a: ?chest for a considerable period of time, causing sig-# E/ d/ J  T, ^5 G1 Z9 k& `
nificant bare skin contact between baby and father.
# U6 Y  p7 ]0 u7 S& F5 Z" `The father also admitted that after the phone call,
; z0 E7 v" ?! }$ @1 k/ h$ wwhen he learned the testosterone level in the baby
% B/ n$ t: D$ b% o- Xwas high, he then read the product information" Z4 _7 _0 Q3 G- [' F% S5 O
packet and concluded that it was most likely the rea-" C1 b9 W; R* q# j2 i6 _
son for the child’s virilization. At that time, they
/ i4 O+ j9 S% X+ u! `decided to put the baby in a separate bed, and the
% P) }# X& j8 I  lfather was not hugging him with bare skin and had
  U  \( W; \$ J2 i% o0 S$ ]been using protective clothing. A repeat testosterone2 w: x0 Z& \6 p6 b) l- F8 C
test was ordered, but the family did not go to the
7 t4 X; ^" \4 s1 mlaboratory to obtain the test.
$ Z0 a( P2 b- M, J9 U. M, IDiscussion
# T. q& N: m) \8 u; ^Precocious puberty in boys is defined as secondary( @1 e2 P3 |% `" x; ^: ^
sexual development before 9 years of age.1,4
3 A7 D# {) i' x8 lPrecocious puberty is termed as central (true) when
+ v2 \# g7 I& Zit is caused by the premature activation of hypo-* q" |+ U1 X9 O+ |
thalamic pituitary gonadal axis. CPP is more com-+ b5 C( t# v5 b# u0 Q. y" m, h( H
mon in girls than in boys.1,3 Most boys with CPP6 n7 ~: U- o: O
may have a central nervous system lesion that is
- S2 T/ j$ H0 X9 r  b* zresponsible for the early activation of the hypothal-4 L, V0 e. y: w% ?6 H5 q
amic pituitary gonadal axis.1-3 Thus, greater empha-  y5 n& M% Z7 ]6 G& @- x$ n
sis has been given to neuroradiologic imaging in
, c% I8 Y. L( w" k' N3 A& Rboys with precocious puberty. In addition to viril-+ ?& W  j( `$ a
ization, the clinical hallmark of CPP is the symmet-
2 n* a6 K1 D7 S" r. N. F+ q  k$ Frical testicular growth secondary to stimulation by. H& n0 ]8 a5 L! ^  H
gonadotropins.1,3: K. B: s" E, h: g: y8 V* W$ f
Gonadotropin-independent peripheral preco-
* d  ?7 c9 D: g3 o8 gcious puberty in boys also results from inappropriate3 v4 e' ?3 [, |* N4 v! e- q3 d
androgenic stimulation from either endogenous or6 d! {: f8 s0 q6 ^0 t. A  r; I
exogenous sources, nonpituitary gonadotropin stim-) E# {# M# M9 g. c, a
ulation, and rare activating mutations.3 Virilizing; w! e" D9 I  A4 s2 m! f- n4 k) c, ]
congenital adrenal hyperplasia producing excessive7 ^# b2 c* h  |
adrenal androgens is a common cause of precocious
2 J- D5 x$ Y1 j: U  p( kpuberty in boys.3,4# I  ?  z# f' a
The most common form of congenital adrenal
5 S* b. k5 y: |1 w2 Ohyperplasia is the 21-hydroxylase enzyme deficiency.2 y% F! J- @4 [+ \: ?/ }, I# ^1 K) j% R
The 11-β hydroxylase deficiency may also result in
" N3 h% X* c8 i7 R+ M8 hexcessive adrenal androgen production, and rarely,
3 {0 J- X3 v8 V# Z' ean adrenal tumor may also cause adrenal androgen  H  S! J' A' Y! @1 m7 s
excess.1,30 b' v4 m$ l4 ~$ E
at University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from) U6 y) n- V% R" {" J; V7 N# n& W
542 Clinical Pediatrics / Vol. 46, No. 6, July 2007! k. x0 Q+ d4 |6 N
A unique entity of male-limited gonadotropin-
2 \3 A0 g+ L5 P, lindependent precocious puberty, which is also known' I9 t) d" }  S9 r- K
as testotoxicosis, may cause precocious puberty at a
! f0 D9 \2 m* V) C  g- f# j; vvery young age. The physical findings in these boys3 ]% Q$ u( N% S6 |/ t+ ^$ m5 ^
with this disorder are full pubertal development,
  P" R% s0 @& i+ W% }- `; }& Pincluding bilateral testicular growth, similar to boys* P* `8 \# p0 Z# _  _
with CPP. The gonadotropin levels in this disorder5 v6 V  u* P# E% Y! P
are suppressed to prepubertal levels and do not show' C/ |) ?& I  P- Y! N0 s  h
pubertal response of gonadotropin after gonadotropin-! ]3 A5 ~+ q/ P) G* s
releasing hormone stimulation. This is a sex-linked
8 R! \# r; z+ L. h- ?/ Vautosomal dominant disorder that affects only) B. {  Y9 M' }$ ~6 M! b
males; therefore, other male members of the family
# k1 C* [3 \' O. E& Tmay have similar precocious puberty.3
- y2 {5 q; y  i, m0 B9 AIn our patient, physical examination was incon-+ p/ x: M$ v" j7 I
sistent with true precocious puberty since his testi-+ z' Q# I9 Q, Q7 l
cles were prepubertal in size. However, testotoxicosis
1 T) _/ v" o# L/ y" iwas in the differential diagnosis because his father3 t2 L3 G5 {" i' W' J7 |
started puberty somewhat early, and occasionally,6 }. b, F2 b4 ^# D, H! T
testicular enlargement is not that evident in the
. o+ M* a+ n, N" j, ]0 @beginning of this process.1 In the absence of a neg-7 z) @" K/ B2 W6 T# j
ative initial history of androgen exposure, our
2 Y. q' M. I( ybiggest concern was virilizing adrenal hyperplasia,' L6 z+ G6 G. z5 ^, `/ h* h" f+ [
either 21-hydroxylase deficiency or 11-β hydroxylase& c, {: w& Q3 C* C3 h4 J& l* \1 Y
deficiency. Those diagnoses were excluded by find-8 l/ G  I$ p7 S$ a, @! i
ing the normal level of adrenal steroids.; _/ m$ F. `4 Y
The diagnosis of exogenous androgens was strongly
$ d; F8 u( R9 r1 A0 E3 tsuspected in a follow-up visit after 4 months because; Z# D/ p' @  R% e# s
the physical examination revealed the complete disap-( \! b5 f+ t2 R& [9 q6 m3 @. C
pearance of pubic hair, normal growth velocity, and* }# z  V( e* ?! w+ A
decreased erections. The father admitted using a testos-; r3 B8 {" T: G. w8 l" @  y( R
terone gel, which he concealed at first visit. He was
9 I4 _4 r  ^& p( L- L" N( Kusing it rather frequently, twice a day. The Physicians’+ D8 R* L, s3 j2 u
Desk Reference, or package insert of this product, gel or4 B8 \% b9 }( i( H4 t; Z9 M
cream, cautions about dermal testosterone transfer to9 a: X2 K; |8 L* q$ E' b% v& j. m5 ?
unprotected females through direct skin exposure.
; c0 n1 ?  z6 C1 C6 ?$ {Serum testosterone level was found to be 2 times the2 R: U; J. |/ L8 Z0 o
baseline value in those females who were exposed to
3 A: F' S' B9 Reven 15 minutes of direct skin contact with their male2 N9 q0 [: f# T% E4 [7 ^' g  p2 B
partners.6 However, when a shirt covered the applica-9 Z* `8 g* s! s% O3 N) U
tion site, this testosterone transfer was prevented.: N+ d; J2 g% Z( d8 D
Our patient’s testosterone level was 60 ng/mL,
% e5 B% O6 n  w1 {- X& S3 mwhich was clearly high. Some studies suggest that
7 H& D9 t0 I' ?% Edermal conversion of testosterone to dihydrotestos-/ r4 X& ~0 {9 i
terone, which is a more potent metabolite, is more6 g  w9 n2 q3 Q
active in young children exposed to testosterone
, L4 \$ V2 x" L; J6 `8 J4 Cexogenously7; however, we did not measure a dihy-
4 G# F/ o$ N3 G" t1 O/ W" k) pdrotestosterone level in our patient. In addition to, D) R1 O! W4 A- y+ S" g+ _  b3 o' v
virilization, exposure to exogenous testosterone in
9 ^# e  \( H' S! I" L) v  r6 vchildren results in an increase in growth velocity and
! W  R! M* r, x' D8 c9 dadvanced bone age, as seen in our patient.
1 b) v* ^, W* m* KThe long-term effect of androgen exposure during6 u( {% h* U8 H3 a
early childhood on pubertal development and final: Z- @5 l1 i3 E2 V
adult height are not fully known and always remain) C! u3 q5 ~0 C; J
a concern. Children treated with short-term testos-
' [4 v2 F: X0 e; R) o0 C- Rterone injection or topical androgen may exhibit some, V+ ~: M4 Y: S
acceleration of the skeletal maturation; however, after: R/ W9 v: |" `+ G: ]3 F9 T7 Z
cessation of treatment, the rate of bone maturation" I* [. N7 d6 R3 V7 Y4 I
decelerates and gradually returns to normal.8,9
4 b) O9 j- `& V$ W* f4 g# h8 q$ f2 YThere are conflicting reports and controversy
! D- J  ^9 G" n0 h, fover the effect of early androgen exposure on adult
& c: x$ s1 E$ J7 {7 @4 I" w* zpenile length.10,11 Some reports suggest subnormal: h) u  i; p1 k$ a
adult penile length, apparently because of downreg-/ Y$ q8 p7 L% H
ulation of androgen receptor number.10,12 However,
( a9 T9 l5 ]. ^. u& P! |Sutherland et al13 did not find a correlation between
+ n2 W! I! {$ \& z  Schildhood testosterone exposure and reduced adult5 m0 i7 K3 G  n4 S$ x! b% V
penile length in clinical studies.
. |4 {; M- @4 g6 g7 ENonetheless, we do not believe our patient is( x0 B- H( A0 [8 @% k1 d- E; y
going to experience any of the untoward effects from0 X8 o: F' R6 Z: `+ \
testosterone exposure as mentioned earlier because
8 j  `6 b: N( x+ Q0 Vthe exposure was not for a prolonged period of time.
5 f: \' \5 ^* e0 c: KAlthough the bone age was advanced at the time of' z" T* [$ S' A/ @9 @# M  P+ S
diagnosis, the child had a normal growth velocity at
$ L9 k1 x1 N& z5 u% H+ F2 p& [7 P" sthe follow-up visit. It is hoped that his final adult
& p( }2 G7 Z# o' I. w* h; u( p" uheight will not be affected.
$ b4 q: _9 J7 M0 ?9 R+ BAlthough rarely reported, the widespread avail-# a/ c1 d7 x5 V; }( }7 ]
ability of androgen products in our society may0 D  w9 d1 C9 M/ |& h7 e
indeed cause more virilization in male or female: G* t% Z( o6 h+ w9 o+ n
children than one would realize. Exposure to andro-
6 i& T) p2 p* _gen products must be considered and specific ques-4 C/ A( o6 O6 W  Y
tioning about the use of a testosterone product or! `) Q5 G& B, ~4 _$ k# c  i; J
gel should be asked of the family members during
9 \+ Y6 H) L$ q; q/ p8 f2 sthe evaluation of any children who present with vir-
8 |+ Q/ c( \8 @2 ^' v4 i& dilization or peripheral precocious puberty. The diag-
: g( U8 U5 t5 b  y2 B$ C7 ?nosis can be established by just a few tests and by) y4 y; l% _3 M' _% T( K0 ?2 L) I
appropriate history. The inability to obtain such a
8 K$ w( T# _+ U8 Mhistory, or failure to ask the specific questions, may
5 O2 X; y: }% W3 H# B% K# ]result in extensive, unnecessary, and expensive
" v* h  {2 h  K! |2 K* o. ~8 Z+ oinvestigation. The primary care physician should be5 d, i, ]4 c" u0 a
aware of this fact, because most of these children% C4 c, @) r7 X* S+ ]
may initially present in their practice. The Physicians’
5 J* c1 |* R7 J: x( MDesk Reference and package insert should also put a) O. g5 }0 x/ a$ o. C! v
warning about the virilizing effect on a male or+ l  F& ]# v/ ^, _- B0 j
female child who might come in contact with some-6 e3 }' N$ K- F# h6 c' X
one using any of these products.
5 b1 X* f. Y2 a" G" Z7 qReferences
" A& o& Q+ r& e  Z. ]1. Styne DM. The testes: disorder of sexual differentiation
  \1 p( _+ f5 k2 R( mand puberty in the male. In: Sperling MA, ed. Pediatric
- h4 k- K. B, |+ N: S% t# dEndocrinology. 2nd ed. Philadelphia, PA: WB Saunders;
, w: |4 F- l, i7 e) S; c- H' ?2002: 565-628.0 L2 H, P3 i0 H1 m! j- z- b( G' I
2. Rivarola M, Belgorosky A, Mendilaharzu H, et al. Precocious
: r) S! k( W- p1 D4 P3 f, j3 Ppuberty in children with tumours of the suprasellar pineal
& L9 X& Y( U3 q3 z% Y& Sat University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from: x  F" ?0 ?8 C
Topical Testosterone Exposure / Bhowmick et al 543
3 m  a8 p& o; [- `areas: organic central precocious puberty. Acta Paediatr./ g# Y, X) c& C+ n# t( K$ ]
2001;90:751-756.. W9 p' ~+ p# `) l( p! Z) i( \
3. Lee PA. Puberty and its disorders. In: Lifshitz F, ed.$ f  r+ P# d& ^9 e6 h
Pediatric Endocrinology. 4th ed. New York, NY: Marcel% k- h, r/ Q# b9 N+ W* ~6 p
Dekker Inc; 2003:211-238.
- ?9 i: S4 w* W8 q4. Yu YM, Punyasavatsu N, Elder D, D’Ercole AJ. Sexual
& D* c7 a7 g: M9 f3 j' h$ Q( I8 Wdevelopment in a two-year-old boy induced by topical& g# h" ~& s$ o/ s% m$ `& }+ k
exposure to testosterone. Pediatrics. 1999;104:e23.
( E4 Z  n% a8 w3 z; s5. Greulich WW, Pyle SI, eds. Radiographic Atlas of
: n; ]/ ~* a9 bSkeletal Development of the Hand and Wrist. 2nd ed.
/ i: ^% c+ J8 nStanford, CA: Stanford University Press; 1959.
& f/ B4 l$ w7 b9 ?0 u9 V3 \6. Physicians’ Desk Reference. Androgel 1% testosterone,
4 G- @2 m$ R3 i; ^: {) XUnimed Pharmaceutical Inc. Montvale, NJ: Medical
- I. C, _$ z7 u# n( w; k% w6 [# BEconomics Company, Inc; 2004:3239-3241.# l9 S0 K' R' }9 O- S; Z8 ?
7. Klugo RC, Cerny JC. Response of micropenis to topical# Q2 _; f: i2 t( F% P, Y
testosterone and gonadotropin. J Urol. 1978;119:( a( U. }1 a0 A0 H( s5 K
667-668.( ?' @: ?- X: E2 z: z
8. Guthrie RD, Smith DW, Graham CB. Testosterone
2 ^1 Y3 _6 e1 p* l  l. W2 btreatment for micropenis during early childhood. J Pediatr.
# I1 O: L5 }# z3 ~  h/ h) a1973;83:247-252.0 ?' Q* |  p: R6 [! ~' N$ i
9. Jacobs SC, Kaplan GW, Gittes RF. Topical testosterone/ c2 S9 }* N, K& V1 a
therapy for penile growth. Urol. 1975;6:708-710.5 E4 |3 |! d2 U+ l! `* \
10. Husmann DA, Cain MP. Microphallus: eventual phallic
$ W& ^( i+ L; D  h. asize is dependent on the timing of androgen administra-
1 a; q5 ]% N, J( U3 H' t" h2 Htion. J Urol. 1994;152:734-739.
  J/ h. P' U) O8 [; |  @' ^11. McMahon DR, Kramer SA, Husmann DA. Micropenis:: c6 V+ M+ l) R3 F
does early treatment with testosterone do more harm
/ n  {" {, ^. C( fthan good? J Urol. 1995;154:825-829.4 u" ^$ \. B8 m# i3 |7 D
12. Takane KK, George FW, Wilson JD. Androgen receptor: x( h; @. h, B# Z6 P" a
of rat penis is down-regulated by androgen. Am J Physiol.# y2 C$ v' x2 |0 g& U
1990;258:E46-E50.# _- H7 F8 T& [3 F
13. Sutherland RS, Kogan BA, Baskin LS, et al. The effect+ a/ w& C3 R# H# f) G2 I8 O# Z
of prepubertal androgen exposure on adult penile
4 R* u2 S4 L8 i. g' vlength. J Urol. 1996;156:783-787.
累計簽到:8 天
連續簽到:3 天
發表於 2025-1-4 13:25:11 | 顯示全部樓層
絕對的好貼!謝謝啊!逐字逐圖地看完這個帖子以後,我的心久久不能平靜,感恩啊!

尚未簽到

發表於 2025-1-5 09:19:02 | 顯示全部樓層
VIP精品區,資源無限好賺金任務區,輕松賺金幣
加入VIP,享受高級特權宣傳賺金又升級,超級棒
看起来不错啊,继续欣赏看看
累計簽到:1555 天
連續簽到:173 天
發表於 2025-1-26 17:11:43 | 顯示全部樓層
VIP精品區,資源無限好賺金任務區,輕松賺金幣
加入VIP,享受高級特權宣傳賺金又升級,超級棒
這個我收藏了!謝謝分享!WK的資源越來越豐富,這少不了大大的辛勞!
累計簽到:263 天
連續簽到:1 天
發表於 2025-1-27 16:30:49 | 顯示全部樓層
這個我收藏了!謝謝分享!WK的資源越來越豐富,這少不了大大的辛勞!
累計簽到:10 天
連續簽到:1 天
發表於 2025-1-29 20:38:58 | 顯示全部樓層
感谢楼主无私分享
 分享同時學會感恩,一句感謝的話語,就是最大的支持!  歡迎交流討論
您需要登錄後才可以回帖 登錄 | 立即注册

本版積分規則


快速回復 返回頂部 返回列表