Progestin-induced virilization

Progestin-induced virilization
SpecialtyGynaecology, endocrinology Edit this on Wikidata

Maternal use of androgens or high doses of certain weakly androgenic synthetic progestogens (progestins) structurally related to testosterone can masculinize (virilize) the vulva of a female fetus during susceptible times in pregnancy.[1][2]

Some degree of fusion of the labioscrotal folds and urogenital folds and clitoral enlargement can occur if exposure occurs from the 8th through the 12th week of gestation, but only clitoral enlargement can occur if exposure occurs after the 12th week.[1][2][3][4] This can in some cases result in ambiguous genitalia.[1]

Fetal masculinization of the vulva is usually due to enzyme abnormalities involved in adrenal steroid biosynthesis, resulting in congenital adrenal hyperplasia (CAH); fetal masculinization of the vulva is much less frequently due to maternal use of androgenic steroids.[3][4]

Fetal masculinization of the vulva due to maternal use of androgenic steroids is generally less advanced than that due to CAH, and unlike CAH, does not cause progressive virilization.[5]

Affected females mature normally with normal fertility, there is almost total regression of the genital anomaly in cases of simple clitoral enlargement, and in even the most severe cases, surgical correction of labioscrotal fusion is relatively simple.[5]

  1. ^ a b c Simpson, Joe Leigh; Kaufman, Raymond H. (1998). "Fetal effects of estrogens, progestogens and diethylstilbestrol". In Fraser, Ian S. (ed.). Estrogens and Progestogens in Clinical Practice (3rd ed.). London: Churchill Livingstone. pp. 533–53. ISBN 978-0-443-04706-0.
  2. ^ a b Carson, Sandra A.; Simpson, Joe Leigh (1983). "Virilization of Female Fetuses following Maternal Ingestion of Progestational and Androgenic Steroids". In Mahesh, Virendra B.; Greenblatt, Robert B. (eds.). Hirsutism and Virilism: Pathogenesis, Diagnosis and Management. Boston: John Wright PSG Inc. pp. 177–188. ISBN 978-0-7236-7045-2.
  3. ^ a b Jaffe, Robert B. (2004). "Disorders of Sexual Development". In Strauss, Jerome F.; Barbieri, Robert L. (eds.). Yen and Jaffe's Reproductive Endocrinology : Physiology, Pathophysiology, and Clinical Management (5th ed.). Philadelphia: Elsevier Saunders. pp. 464–491. ISBN 978-0-7216-9546-4.
  4. ^ a b Forest, Maguelone G. (2006). "Diagnosis and Treatment of Disorders of Sexual Development". In DeGroot, Leslie J.; Jameson, J. Larry (eds.). Endocrinology (5th ed.). Philadelphia: Elsevier Saunders. pp. 2779–829. ISBN 978-0-7216-0376-6.
  5. ^ a b Schardein JL (1980). "Congenital abnormalities and hormones during pregnancy: a clinical review". Teratology. 22 (3): 251–70. doi:10.1002/tera.1420220302. PMID 7015547.