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]
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!
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
2 V' r, c8 w' \2 ^! T# Bprecocious puberty (CPP), which is mediated
* ^! F* }" E- W! M5 ]7 l( Rthrough the hypothalamic pituitary gonadal axis, has! o% F1 d' L. @# ~" T9 I
a higher incidence of organic central nervous system( W% T3 t& E1 l/ M2 j- ^
lesions in boys.1,2 Virilization in boys, as manifested
: d& D/ K8 S/ x1 z( U/ x, mby enlargement of the penis, development of pubic
! ]3 v; \3 D5 H7 w! E! _1 f8 whair, and facial acne without enlargement of testi-
5 g" i  Y& S1 o& P: t+ k4 qcles, suggests peripheral or pseudopuberty.1-3 We& X, O' g0 g3 p) j$ Y
report a 16-month-old boy who presented with the
# v7 \. {# z5 U+ D+ v3 l1 p8 Ienlargement of the phallus and pubic hair develop-
4 L" e3 Y! s2 mment without testicular enlargement, which was due+ p( ^( I7 _: H( n' a7 ?
to the unintentional exposure to androgen gel used by6 a3 {1 C7 x& d( u. o+ S' l
the father. The family initially concealed this infor-- j$ g8 }) b- ~0 X
mation, resulting in an extensive work-up for this
! ^, o. z! B: M1 r4 a3 K: _child. Given the widespread and easy availability of
! q! Q# r7 g  C5 c0 Y5 Z* L# {testosterone gel and cream, we believe this is proba-
; U  }: J; p% C( s  l0 jbly more common than the rare case report in the
6 X) w% |" E. D3 P& g' Vliterature.4
( E( e+ A9 X7 f7 EPatient Report
6 N, A/ ]6 @% E$ F; B+ w. s- ?* @A 16-month-old white child was referred to the
5 s( Y3 C+ z! ]: i; `; eendocrine clinic by his pediatrician with the concern
) C% g6 Z7 k% D0 _' W% y" I+ fof early sexual development. His mother noticed
: z0 Y2 ]7 s' G0 y* D8 I: }+ }light colored pubic hair development when he was
. T; i$ y- p" x" i6 A7 bFrom the 1Division of Pediatric Endocrinology, 2University of
0 C% ^+ ~' I. L7 z0 r6 iSouth Alabama Medical Center, Mobile, Alabama.
2 ~, |; {) K( r/ p* l; d. wAddress correspondence to: Samar K. Bhowmick, MD, FACE,2 A7 c8 Y0 h+ w  x9 H/ T$ S
Professor of Pediatrics, University of South Alabama, College of
  a, h# c' T* D6 s; W0 q9 DMedicine, 2451 Fillingim St. Mastin 212, Mobile, AL 36617-2297;
* e6 B( j3 K+ We-mail: [email protected].
) u0 _: z( E* J  D: I; Labout 6 to 7 months old, which progressively became+ M3 W+ c+ d' u4 E% B
darker. She was also concerned about the enlarge-
; E$ c" x7 i1 E$ _, U# c, O% N/ E8 A( sment of his penis and frequent erections. The child
! K9 U' k( I  }8 u: t, owas the product of a full-term normal delivery, with4 P) S9 f& w$ I: [, [+ ~
a birth weight of 7 lb 14 oz, and birth length of
$ u- ]8 s8 _$ ?6 |20 inches. He was breast-fed throughout the first year
6 D3 d3 S& p$ s7 ]2 d1 Y: Sof life and was still receiving breast milk along with7 e) n* o; h' ?$ B
solid food. He had no hospitalizations or surgery,2 C6 r2 Y$ i7 w
and his psychosocial and psychomotor development
6 k  z2 F5 O% i, s' |2 Cwas age appropriate.  i3 I5 D. v& [. Q, C3 o$ u+ N9 v+ B
The family history was remarkable for the father,
4 H9 t  `) D; Q( jwho was diagnosed with hypothyroidism at age 16,' o- K8 C/ _* B. z6 V! ~, L! c7 `
which was treated with thyroxine. The father’s) D6 ]8 h  ~) Z1 r/ ]  K9 M: k
height was 6 feet, and he went through a somewhat( Y# c6 o/ s+ m  h3 @9 ]
early puberty and had stopped growing by age 14.
0 ]: \5 N$ A3 w' n2 O. H$ _The father denied taking any other medication. The
$ S" Q# f* W- X3 d- _; h9 x  fchild’s mother was in good health. Her menarche9 T8 ~1 n  H1 \
was at 11 years of age, and her height was at 5 feet1 f8 X1 g- ]0 E9 d- f
5 inches. There was no other family history of pre-
: l. h4 p" r9 T" }# kcocious sexual development in the first-degree rela-
  U6 i" C% j! |6 b3 ytives. There were no siblings./ O9 |3 P5 P$ _4 h3 m, r* m8 T
Physical Examination- @  U4 P2 H! N$ G8 ?% u! {
The physical examination revealed a very active,3 S  f8 j7 Y0 Z" e. }' d/ _
playful, and healthy boy. The vital signs documented' t( o+ l1 W3 T: o' n1 K# b( L
a blood pressure of 85/50 mm Hg, his length was4 y, i! ?( b1 J' B5 k( d: }! Z6 M
90 cm (>97th percentile), and his weight was 14.4 kg
) y9 ]( a3 S0 Y( s; k! Q* ](also >97th percentile). The observed yearly growth  `, n$ G/ k0 G
velocity was 30 cm (12 inches). The examination of/ i+ H1 ~+ n  \; f
the neck revealed no thyroid enlargement., @, K+ ~% p) l* Y4 O$ n* n
The genitourinary examination was remarkable for3 W! v; r$ w7 V4 u! F& m, q
enlargement of the penis, with a stretched length of/ z. B0 r9 g# q
8 cm and a width of 2 cm. The glans penis was very well2 ^0 ~1 n$ X; M# q! M; u) e/ |
developed. The pubic hair was Tanner II, mostly around0 y2 {& B: N: W8 y3 C$ c
5407 B: @0 w! g. O- J
at University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from# w  \4 q+ g' W% ~7 f
the base of the phallus and was dark and curled. The, c6 Z. R  m- s: F/ |9 p
testicular volume was prepubertal at 2 mL each.
2 {+ i8 C( g" _5 lThe skin was moist and smooth and somewhat
. Y0 F1 |  V6 Z6 [# `( N2 \( k0 moily. No axillary hair was noted. There were no" f0 O) w7 m% w( y$ f1 A
abnormal skin pigmentations or café-au-lait spots.! s7 C3 E6 w9 n( l
Neurologic evaluation showed deep tendon reflex 2+
) f/ S$ q- D& y5 x+ Wbilateral and symmetrical. There was no suggestion: E. @- J+ E2 ~/ t' M
of papilledema.
  U: m1 N2 t$ }Laboratory Evaluation
. @' Z3 P2 Q& @4 H4 ?& r0 hThe bone age was consistent with 28 months by- N: l3 ?) {0 X
using the standard of Greulich and Pyle at a chrono-& M$ d/ z+ \/ g  a& _2 S
logic age of 16 months (advanced).5 Chromosomal. W# [3 `3 @: K. [& n7 T1 @# n
karyotype was 46XY. The thyroid function test
# @" C; a7 X1 i' jshowed a free T4 of 1.69 ng/dL, and thyroid stimu-
1 F9 N% ]7 `- k' T- Alating hormone level was 1.3 µIU/mL (both normal).* S! z' U9 c- q  {1 D
The concentrations of serum electrolytes, blood
6 N+ {2 V  w  G# T, X2 durea nitrogen, creatinine, and calcium all were
9 T9 w2 k  V1 `( Z- f& dwithin normal range for his age. The concentration
& ?2 T* g7 O+ q- J/ j1 m# Xof serum 17-hydroxyprogesterone was 16 ng/dL
' \8 w! N8 x0 D$ Q2 I% a, {9 y3 j(normal, 3 to 90 ng/dL), androstenedione was 20
: F4 ^3 I2 `) V: R& `: [9 Bng/dL (normal, 18 to 80 ng/dL), dehydroepiandros-
" G$ ^0 Z+ h2 I9 T0 Xterone was 38 ng/dL (normal, 50 to 760 ng/dL),
1 r5 Q- x  h& @  e! B* qdesoxycorticosterone was 4.3 ng/dL (normal, 7 to
8 n& X0 `5 m. }& l2 |49ng/dL), 11-desoxycortisol (specific compound S)
; }4 ~3 \) }& C, f3 f, d; N" u1 J- Swas 43 ng/dL (normal, 10 to 156 ng/dL), serum cor-
, o+ U/ w' }' e# K) T$ Z9 stisol was 7.6 µg/dL (normal, 2.8 to 23 µg/dL), total
" }* P) o* ]* }! d  W. g' S: P' stestosterone was 60 ng/dL (normal <3 to 10 ng/dL),
5 a, C6 z6 o4 k+ I: ?3 m' aand β-human chorionic gonadotropin was less than
& }- x1 y9 x) e; V# Q5 L, M5 mIU/mL (normal <5 mIU/mL). Serum follicular; e! O% k0 Q/ b& Z
stimulating hormone and leuteinizing hormone8 m! a2 t4 F7 B% r+ r
concentrations were less than 0.05 mIU/mL3 }6 f: F& e# _5 }
(prepubertal).0 \3 p: k7 \+ x: a! ^
The parents were notified about the laboratory6 }# ^; g# g; U( ]) N0 @. J  D
results and were informed that all of the tests were6 g0 E8 P/ j1 m8 ^
normal except the testosterone level was high. The
' ~# f0 n) F' w/ E9 ~4 }follow-up visit was arranged within a few weeks to
8 `/ o/ N; u2 F( ~obtain testicular and abdominal sonograms; how-
+ p; T5 B- C0 e  V+ _# I0 }ever, the family did not return for 4 months.
0 Z2 D/ r5 {  [# \# DPhysical examination at this time revealed that the
7 v* N; C$ m  y! Zchild had grown 2.5 cm in 4 months and had gained
! j5 _+ v! b0 g1 A) W; J2 kg of weight. Physical examination remained# u, e6 J6 J8 M( N* t
unchanged. Surprisingly, the pubic hair almost com-' v. b" r! H, B) _0 K  o% f
pletely disappeared except for a few vellous hairs at$ v1 p' r' v7 q; V: ~
the base of the phallus. Testicular volume was still 2
! c2 `6 r$ s  o1 y( U5 emL, and the size of the penis remained unchanged.
4 B  |( }5 k, h' |" bThe mother also said that the boy was no longer hav-
1 D) U* x( g! ]/ H# {ing frequent erections.
% K$ X7 L# @4 P5 d8 L, }6 mBoth parents were again questioned about use of
1 Z: Y) v/ Q: X+ Y: Nany ointment/creams that they may have applied to
/ \5 a  B$ h6 O+ M; U; j8 \/ \the child’s skin. This time the father admitted the2 z6 g  [' ?4 V2 J& Q1 B
Topical Testosterone Exposure / Bhowmick et al 541! E( ]4 c6 H1 F8 l
use of testosterone gel twice daily that he was apply-9 W' t4 R0 X  }# ]1 E- u
ing over his own shoulders, chest, and back area for: b: T7 q2 h/ T8 Z( n% K2 K9 y$ K3 e
a year. The father also revealed he was embarrassed. T  K) J7 A7 @2 v$ |8 Z- ^2 ?/ q* a
to disclose that he was using a testosterone gel pre-. ]) e: Z6 U: v3 T
scribed by his family physician for decreased libido& C% p9 s5 }7 s/ y
secondary to depression.9 z  T" D) N" o$ f/ e- Z
The child slept in the same bed with parents.
4 c# `/ c- v# d) Q0 k7 }- w! n/ IThe father would hug the baby and hold him on his
. X; ?. o6 B' [' Pchest for a considerable period of time, causing sig-0 `0 r0 A2 z& `
nificant bare skin contact between baby and father.3 v8 g8 O3 P9 g  O; U5 p* }% h2 ?
The father also admitted that after the phone call,
0 ^0 H8 {3 q$ u. S5 ]. Cwhen he learned the testosterone level in the baby; d! a" b! S7 w% a! F
was high, he then read the product information
* ^. c* o+ H% H3 T; ~3 M) hpacket and concluded that it was most likely the rea-4 A+ |* ^6 _; |1 n. R
son for the child’s virilization. At that time, they6 M, V7 U- Q( ^, Q" h
decided to put the baby in a separate bed, and the$ J2 U8 p8 F/ V1 V. M) M9 r
father was not hugging him with bare skin and had
) R% w/ q( V. d5 abeen using protective clothing. A repeat testosterone
: v  C6 L5 }5 Utest was ordered, but the family did not go to the
" n5 e; \  f* i2 c# y3 k& M1 R8 \/ mlaboratory to obtain the test.+ D. u" M4 g' e3 }! ~" M. G
Discussion. n4 d& a7 y. o
Precocious puberty in boys is defined as secondary
* F: M* j- o9 r. H- S( [4 X: }sexual development before 9 years of age.1,4
+ \9 x9 [# M/ m1 G2 ]( JPrecocious puberty is termed as central (true) when
. M2 ?5 K, o' V" ]0 J' @it is caused by the premature activation of hypo-
  S9 n4 m) ~3 I8 G3 pthalamic pituitary gonadal axis. CPP is more com-
1 ?, P5 W+ b) R. d3 O5 G! Hmon in girls than in boys.1,3 Most boys with CPP" J  S; Y: y! H3 c, |, D
may have a central nervous system lesion that is; Y1 w+ ^& a* K5 D
responsible for the early activation of the hypothal-" W" \' F# |# E, Q
amic pituitary gonadal axis.1-3 Thus, greater empha-4 @, ?4 P' H2 v" R9 K- J
sis has been given to neuroradiologic imaging in
+ _! Q' Z/ L( u- i* Pboys with precocious puberty. In addition to viril-% q7 t, e9 d- Y# \
ization, the clinical hallmark of CPP is the symmet-
/ E# k$ Q* |0 w: U: Brical testicular growth secondary to stimulation by4 {! Q1 S% V. h, P( `. a
gonadotropins.1,3
% f8 v! n# R' j# C& d/ B: bGonadotropin-independent peripheral preco-
" ^& v$ f" P* Z3 d% N/ Hcious puberty in boys also results from inappropriate
( ]( u& L3 _5 [* _8 K5 g* oandrogenic stimulation from either endogenous or
1 Q! H( N$ j4 D* O8 z  O3 Pexogenous sources, nonpituitary gonadotropin stim-
3 Y3 Z# @: ^7 A+ U, \( d3 Eulation, and rare activating mutations.3 Virilizing4 o4 F- S& E8 I& b/ G2 d$ i( ^( a9 b
congenital adrenal hyperplasia producing excessive
5 ]% K5 D; q/ G, Dadrenal androgens is a common cause of precocious
" ^9 P3 i  f" X! q5 {4 cpuberty in boys.3,4
! L9 W8 V) W) w3 n! s  t/ {The most common form of congenital adrenal7 t' T2 x. S- y: A6 q9 \
hyperplasia is the 21-hydroxylase enzyme deficiency.
1 k1 g% L: p( B/ \( w$ e$ t( KThe 11-β hydroxylase deficiency may also result in
2 F& F: @9 L, Y4 B& e: k. B2 Dexcessive adrenal androgen production, and rarely,
: n. V/ m- t9 ?, ]an adrenal tumor may also cause adrenal androgen
4 q. Y# s! y; n, Z& F1 S3 uexcess.1,3+ b" G6 |+ T6 c' S5 G5 M5 ]( z6 J
at University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from* N( K% r0 t+ \6 T
542 Clinical Pediatrics / Vol. 46, No. 6, July 2007
% o  q2 l. b* u, F2 n# a; XA unique entity of male-limited gonadotropin-
" f0 o( _- T4 j; e8 B) F. R# Aindependent precocious puberty, which is also known/ z5 l; b6 E6 G; n
as testotoxicosis, may cause precocious puberty at a6 f: L- p6 D9 B8 f
very young age. The physical findings in these boys
% T) _! B9 L$ S" w7 _/ W! Nwith this disorder are full pubertal development,
% h3 S7 ^- y, F0 T" Wincluding bilateral testicular growth, similar to boys
% M5 M) @6 T9 Y, [. |+ L7 z9 }with CPP. The gonadotropin levels in this disorder, Q2 [# I5 Z! C$ G
are suppressed to prepubertal levels and do not show
& a, t+ p; J% R- p/ S  i5 }: Q* }pubertal response of gonadotropin after gonadotropin-% l& K/ {7 b0 m* Z4 h3 f
releasing hormone stimulation. This is a sex-linked
* G' N9 E% d, K$ ~: e+ Yautosomal dominant disorder that affects only  C, m! F. a. `2 {
males; therefore, other male members of the family
  n5 m; e  O9 S% _may have similar precocious puberty.30 D4 l+ H& G$ [- ~: U
In our patient, physical examination was incon-
& L5 {( ~/ u8 H$ `/ Ysistent with true precocious puberty since his testi-0 g/ ^% S6 T* r; Q6 W
cles were prepubertal in size. However, testotoxicosis
6 T) `: J  U* ~" Nwas in the differential diagnosis because his father
1 m; p: G8 G' S$ tstarted puberty somewhat early, and occasionally,  M6 U% m' l0 B; h
testicular enlargement is not that evident in the" s3 G4 q1 B7 u
beginning of this process.1 In the absence of a neg-  J4 ^; i4 y, @+ f
ative initial history of androgen exposure, our5 m& [) }8 l" x! V0 G! t; r" I2 t
biggest concern was virilizing adrenal hyperplasia,
* `; }' E1 ?  veither 21-hydroxylase deficiency or 11-β hydroxylase# K$ w2 H; x" O2 }2 b
deficiency. Those diagnoses were excluded by find-& q& v9 T& Q/ H. f8 s
ing the normal level of adrenal steroids.
: q6 n! P) ^  ], ^: i- ^( nThe diagnosis of exogenous androgens was strongly
) Y: T9 N$ d: G- f- psuspected in a follow-up visit after 4 months because
3 `. {) L  a3 ithe physical examination revealed the complete disap-
8 E2 O5 {4 X( }, Ppearance of pubic hair, normal growth velocity, and
+ [. k+ I1 @% ?9 Q! vdecreased erections. The father admitted using a testos-8 ?! k. q8 y5 k" t5 ~
terone gel, which he concealed at first visit. He was* L/ C( H& m  F% q; C9 X, l
using it rather frequently, twice a day. The Physicians’# T/ G/ x: b- z* \% y' p
Desk Reference, or package insert of this product, gel or7 f# @6 m! {' p* s
cream, cautions about dermal testosterone transfer to
& v9 j* z8 t3 Runprotected females through direct skin exposure.
" F: I4 H* y. kSerum testosterone level was found to be 2 times the
3 V9 _, L4 }4 y5 U- \3 _baseline value in those females who were exposed to2 d' h! }9 ~% V4 o# P
even 15 minutes of direct skin contact with their male
5 I5 z8 D/ c/ N0 M$ V4 \& H; Wpartners.6 However, when a shirt covered the applica-, Y9 B% h8 W; u9 a6 i3 p
tion site, this testosterone transfer was prevented.
- c% z" R7 U; K- @2 GOur patient’s testosterone level was 60 ng/mL,
( w3 b( N$ J& E; N$ ?which was clearly high. Some studies suggest that* W* t, t7 a& H6 J
dermal conversion of testosterone to dihydrotestos-/ W' e2 g: M  c
terone, which is a more potent metabolite, is more) `7 L# n) [. I$ p7 t; \* }9 y
active in young children exposed to testosterone# p5 j/ h* p0 i! `% L8 w
exogenously7; however, we did not measure a dihy-
5 K$ J% F2 B' fdrotestosterone level in our patient. In addition to
5 ~6 ^& D, X% l" X+ _* fvirilization, exposure to exogenous testosterone in
0 O6 j' o1 ^. ]( nchildren results in an increase in growth velocity and8 p+ b0 ^% B" Z. e# a3 g( b/ t
advanced bone age, as seen in our patient.
/ M. e" H$ q6 j) Y! T* L2 KThe long-term effect of androgen exposure during
; v& B# v! a! iearly childhood on pubertal development and final, c0 J$ h" C) G  C: w' ^3 W5 g/ I
adult height are not fully known and always remain6 o) y2 C3 X9 D- u
a concern. Children treated with short-term testos-* I, m9 ~" T5 R# y) t5 n
terone injection or topical androgen may exhibit some
8 F8 n7 j2 X! {) n' q0 v$ ]acceleration of the skeletal maturation; however, after
$ m1 k" y) _' a& D% Lcessation of treatment, the rate of bone maturation
, X$ L; f  ?$ v. p6 }% Mdecelerates and gradually returns to normal.8,9
- l+ X- G9 ^$ E  t$ o7 hThere are conflicting reports and controversy
% c6 f. @5 ?  l( Lover the effect of early androgen exposure on adult) k2 i0 ^9 l2 M" J
penile length.10,11 Some reports suggest subnormal
' n8 L  O( F- V/ D+ l9 \, Gadult penile length, apparently because of downreg-
( |7 u5 E& `" Y3 A+ D: |4 K9 pulation of androgen receptor number.10,12 However,
2 I5 H- P4 B7 p0 |; nSutherland et al13 did not find a correlation between' _8 |) j9 |" K/ W/ R7 g) I, j2 `
childhood testosterone exposure and reduced adult6 d0 {# c8 |9 i( M; r  _% w2 l. S
penile length in clinical studies.
$ \+ V# r$ n5 j$ iNonetheless, we do not believe our patient is; |" P% n) b8 O! T4 K0 Z) }# E
going to experience any of the untoward effects from  P& g& b2 ]3 r! }* [$ x
testosterone exposure as mentioned earlier because6 }3 A1 G! J+ N- Y+ k% |' i: ~  S
the exposure was not for a prolonged period of time.6 E: \. ~5 d' D9 \5 M
Although the bone age was advanced at the time of  O# X( b, j  R
diagnosis, the child had a normal growth velocity at; ?) i* f9 w1 _. n9 L3 M% G
the follow-up visit. It is hoped that his final adult, y6 x  A0 A8 N  a) z
height will not be affected.4 r' ~3 _3 N& s5 g6 |
Although rarely reported, the widespread avail-
: r2 a4 L! N0 ^( q0 cability of androgen products in our society may
) t* @! c9 U) o- Oindeed cause more virilization in male or female
# K/ e1 |  I  I7 D8 N3 z4 {. b4 cchildren than one would realize. Exposure to andro-
& c* z. C% P- b7 V# f2 ?* Qgen products must be considered and specific ques-5 [8 N8 p" I# F7 {0 R" `+ T
tioning about the use of a testosterone product or9 c# g* q" P9 y1 c/ |
gel should be asked of the family members during
( @3 M9 W/ V2 q- Ithe evaluation of any children who present with vir-$ o& T/ I: s' f) V
ilization or peripheral precocious puberty. The diag-
# ?4 `, X$ `* e# o: \3 |8 \' anosis can be established by just a few tests and by5 ]9 S/ I% L$ v4 L; `& L, Y& z
appropriate history. The inability to obtain such a& ^$ n4 S, B/ g6 S
history, or failure to ask the specific questions, may
) Q) V" H9 b0 f) j4 lresult in extensive, unnecessary, and expensive. A+ _2 V3 ~/ G' G  U8 M
investigation. The primary care physician should be! l* i, I! z8 W6 s. u
aware of this fact, because most of these children8 l2 K& S% ?2 I$ h5 ^% ]8 M; o8 M
may initially present in their practice. The Physicians’( B( e5 x. M0 N: T# b5 r
Desk Reference and package insert should also put a6 z# K& r4 [" V1 I( E7 W8 O8 G
warning about the virilizing effect on a male or
- s& S6 m- ?& O9 F: U! Cfemale child who might come in contact with some-0 [+ b4 m: G) L0 W! w* N6 O
one using any of these products.
1 E& b. c, a" ^( n8 rReferences- v( z, A6 C% w9 H
1. Styne DM. The testes: disorder of sexual differentiation  G' a% X" H* X  d) Q  [" J1 F
and puberty in the male. In: Sperling MA, ed. Pediatric
8 x/ u. O6 Z( B% z( M' I2 _. XEndocrinology. 2nd ed. Philadelphia, PA: WB Saunders;% e& r! g# R" e; x* b
2002: 565-628.
  P0 z4 U/ u8 W8 S* K2. Rivarola M, Belgorosky A, Mendilaharzu H, et al. Precocious" B5 F. K7 l1 W2 G4 T' [; N5 M2 f
puberty in children with tumours of the suprasellar pineal4 K' E( K& t; i, S1 }% h
at University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from
. [' a. D2 l, I2 a) N# ^! xTopical Testosterone Exposure / Bhowmick et al 5432 a% V, o  m9 {& \
areas: organic central precocious puberty. Acta Paediatr.
4 P) d& z; l, |' j6 r  H# k2001;90:751-756.
; a% F- B& C9 {( g3. Lee PA. Puberty and its disorders. In: Lifshitz F, ed./ u3 K% c6 I( @
Pediatric Endocrinology. 4th ed. New York, NY: Marcel' l+ ?& J. g* L: x  s( j, y
Dekker Inc; 2003:211-238.
% ?- M: ?9 f4 f% f4. Yu YM, Punyasavatsu N, Elder D, D’Ercole AJ. Sexual% ^# ~7 h( L4 ^3 W( `
development in a two-year-old boy induced by topical
7 ^' s* \# O' ?exposure to testosterone. Pediatrics. 1999;104:e23.
/ M; l1 Z! I4 k5. Greulich WW, Pyle SI, eds. Radiographic Atlas of
% c+ C2 M" ]. K3 nSkeletal Development of the Hand and Wrist. 2nd ed.4 z( t/ k' v! N5 e# [3 N' {: o
Stanford, CA: Stanford University Press; 1959.+ b6 `+ N% Q7 w0 a! v$ h8 j# `
6. Physicians’ Desk Reference. Androgel 1% testosterone,$ h+ Q; @! H9 R6 x  \0 q  z6 P
Unimed Pharmaceutical Inc. Montvale, NJ: Medical& N5 d* c1 w" o0 p  ~
Economics Company, Inc; 2004:3239-3241.
. l& E6 y% B7 t% @, [7. Klugo RC, Cerny JC. Response of micropenis to topical) L4 \5 X! d" I' l
testosterone and gonadotropin. J Urol. 1978;119:
4 T# L" `( M2 a3 Z2 c+ P# f667-668.
) w5 y7 m! y. D$ t  T& U' k8. Guthrie RD, Smith DW, Graham CB. Testosterone
' u/ y. l4 k3 gtreatment for micropenis during early childhood. J Pediatr.
. a( s; r3 t0 G" E( C1973;83:247-252.
+ U- J* S; e- z( F- C9. Jacobs SC, Kaplan GW, Gittes RF. Topical testosterone
9 n) Y9 V; r* k8 ^/ V8 atherapy for penile growth. Urol. 1975;6:708-710.
1 ]8 h" c, a( z2 g) a10. Husmann DA, Cain MP. Microphallus: eventual phallic
9 H$ W( x; ?$ b) w( R, jsize is dependent on the timing of androgen administra-0 F) c  g$ I1 ~* ?6 D
tion. J Urol. 1994;152:734-739.
7 @- T8 @$ j# D" e( T5 |+ }11. McMahon DR, Kramer SA, Husmann DA. Micropenis:1 h: h4 r9 L  v+ R- U# m
does early treatment with testosterone do more harm
' B- W9 A! v, J7 v* Gthan good? J Urol. 1995;154:825-829./ c! k- J; q% l* g& ~- w2 n
12. Takane KK, George FW, Wilson JD. Androgen receptor0 m" V! i! h0 t3 ]; L
of rat penis is down-regulated by androgen. Am J Physiol.0 T  a/ U3 Q) q9 z
1990;258:E46-E50.
$ ~1 n1 B, H3 Y* a. l& O13. Sutherland RS, Kogan BA, Baskin LS, et al. The effect- C2 x9 e+ c) s! m: i( `8 p8 W# A; N
of prepubertal androgen exposure on adult penile5 N% a4 _' h% G; ?6 I. P. @: I
length. J Urol. 1996;156:783-787.
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!
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
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!
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!
發表於 2025-1-29 20:38:58 | 顯示全部樓層
感谢楼主无私分享
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