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
0 b# o- }* a: ]7 U" ~/ T% hprecocious puberty (CPP), which is mediated
: a8 _& y1 G3 n5 S( {% `& Othrough the hypothalamic pituitary gonadal axis, has0 Y5 b2 @/ W6 r5 Q, }' C
a higher incidence of organic central nervous system
! b# V6 W1 ^6 P+ F# ~9 F$ Blesions in boys.1,2 Virilization in boys, as manifested! G7 J; r& e4 {, r
by enlargement of the penis, development of pubic
! f" _4 j! J/ {: E+ f* Whair, and facial acne without enlargement of testi-% M  Q" P$ @5 V3 F$ n3 p5 i3 M1 g
cles, suggests peripheral or pseudopuberty.1-3 We  }# D; G* r& @+ T4 v& K
report a 16-month-old boy who presented with the
8 r# m$ r# u+ V, penlargement of the phallus and pubic hair develop-
8 K. {. r/ @& r$ V# gment without testicular enlargement, which was due3 B, r" V% k# \
to the unintentional exposure to androgen gel used by  e$ i0 }* s4 N
the father. The family initially concealed this infor-
/ M# x# a9 H8 pmation, resulting in an extensive work-up for this  g! ?- x. M$ r1 |
child. Given the widespread and easy availability of- P  F( C/ i2 E; Z
testosterone gel and cream, we believe this is proba-
' @" m# }5 |4 _: zbly more common than the rare case report in the
! r* @* O# p) L, W/ E$ @) Y7 Dliterature.4
% w% t! [  {. E( qPatient Report$ R7 w% v( q: C2 ~
A 16-month-old white child was referred to the
8 T( v# n, m' S' ~; ?1 xendocrine clinic by his pediatrician with the concern. K: Z* }) y6 \8 O7 A
of early sexual development. His mother noticed% i( n6 l* P  Y% @8 n
light colored pubic hair development when he was
9 n, r4 ~# R+ }) G$ x$ z2 q' k4 `From the 1Division of Pediatric Endocrinology, 2University of
0 w+ w* W6 f; w( T, m4 H3 iSouth Alabama Medical Center, Mobile, Alabama.! ]7 C  }' J% }
Address correspondence to: Samar K. Bhowmick, MD, FACE,
/ I8 o3 f, L0 P+ N+ d4 \" I2 t- s+ gProfessor of Pediatrics, University of South Alabama, College of
1 L0 p7 }! s1 Y+ G8 @Medicine, 2451 Fillingim St. Mastin 212, Mobile, AL 36617-2297;
- D' A/ Y! T  d  p5 z; a7 V6 Se-mail: [email protected].7 @. L; o! h' F6 V3 z
about 6 to 7 months old, which progressively became
. s5 z8 t2 y* q9 x# g9 `darker. She was also concerned about the enlarge-
' E: I" j* J- M6 o, g5 ?ment of his penis and frequent erections. The child
3 f1 @5 r$ i1 B. ~  Q6 Nwas the product of a full-term normal delivery, with
. U" p) I4 `! n3 Ma birth weight of 7 lb 14 oz, and birth length of
# z: n  r& ^( ?; r/ r) ^20 inches. He was breast-fed throughout the first year/ X2 ]- W2 {& T+ I
of life and was still receiving breast milk along with
% f7 [8 D- M) Z; }solid food. He had no hospitalizations or surgery,
8 Y  [0 l  D& a: P, Mand his psychosocial and psychomotor development
3 s5 w7 f) W4 |% E5 _9 d( t% L4 ~was age appropriate.2 K- J8 R; Z% ^( y
The family history was remarkable for the father,
1 z. |4 e* X' K8 O% y2 H* b, ~- Qwho was diagnosed with hypothyroidism at age 16,
+ m' _- ]9 {, _) l( ^7 Vwhich was treated with thyroxine. The father’s
2 G* g8 f" ?5 f5 M: o3 ?height was 6 feet, and he went through a somewhat; s- w7 R- T3 g8 A- Y# X
early puberty and had stopped growing by age 14." v% m$ i. a, l
The father denied taking any other medication. The. n# A* \- c! k- r* z9 T1 O
child’s mother was in good health. Her menarche# I" S+ r( Z( w( W5 T! `
was at 11 years of age, and her height was at 5 feet; f/ k6 p0 ?; _) M
5 inches. There was no other family history of pre-
' o4 H2 [7 m! R# ncocious sexual development in the first-degree rela-
9 W' F7 x5 K" v  A7 M2 A# Htives. There were no siblings.9 ~+ K' [) c5 w: |: Z) E2 W/ j9 N
Physical Examination
$ M4 W$ \+ L3 n& |The physical examination revealed a very active,
$ E  C( O0 ], t- \/ c" Wplayful, and healthy boy. The vital signs documented$ o. V- U6 F) M
a blood pressure of 85/50 mm Hg, his length was+ W3 \1 y( w/ B  r& Q- O& z; ^
90 cm (>97th percentile), and his weight was 14.4 kg
3 |2 r7 Y6 W2 H) j(also >97th percentile). The observed yearly growth- p4 p. ^' C9 ~7 i+ x
velocity was 30 cm (12 inches). The examination of3 ]" R/ I* ]/ I( |6 T/ L
the neck revealed no thyroid enlargement., O9 O* v- B* I& R" a
The genitourinary examination was remarkable for
9 P: U0 I" _" B- [enlargement of the penis, with a stretched length of
0 P( ^3 E8 N1 b2 ?/ B8 cm and a width of 2 cm. The glans penis was very well/ n8 g3 @* }* @0 W/ I" P& C+ f- b  w
developed. The pubic hair was Tanner II, mostly around9 E, `/ d- @" i/ g+ W& ~
540
# b$ m5 X6 r) N0 [) U9 Nat University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from& B& _* U+ q: e9 v) [
the base of the phallus and was dark and curled. The* c! I& q2 e0 q+ _* R6 J
testicular volume was prepubertal at 2 mL each.6 Z* w7 y$ I" F4 \( q% L
The skin was moist and smooth and somewhat
9 O6 w. C; F8 Y/ ]oily. No axillary hair was noted. There were no7 ?6 ?7 L1 Y7 t, c: _. A
abnormal skin pigmentations or café-au-lait spots.
% v! s0 q) H3 gNeurologic evaluation showed deep tendon reflex 2+7 a1 r8 ~$ L: u4 a8 A+ O% p) W
bilateral and symmetrical. There was no suggestion
7 q0 i# Z% o' Y% R7 ~. c  zof papilledema., D8 y* l4 q& `5 A0 o  f
Laboratory Evaluation$ D9 ^* q1 j& B
The bone age was consistent with 28 months by
5 D2 Y; o$ E: |  f5 eusing the standard of Greulich and Pyle at a chrono-4 c' x7 w6 j$ C  ~/ f) s( Q; z$ N6 u
logic age of 16 months (advanced).5 Chromosomal
' }8 N; R( Y( Okaryotype was 46XY. The thyroid function test+ v2 Z* U2 h5 h( v: c
showed a free T4 of 1.69 ng/dL, and thyroid stimu-
$ M( b4 i2 S6 Vlating hormone level was 1.3 µIU/mL (both normal).1 @# Y4 S  v1 |6 {
The concentrations of serum electrolytes, blood
5 ~3 _- t6 I7 d3 _0 f1 e4 c  \urea nitrogen, creatinine, and calcium all were+ @7 u) ?( e; n- U: \
within normal range for his age. The concentration
& f+ `8 L- Y2 ~* Eof serum 17-hydroxyprogesterone was 16 ng/dL( @+ i- Q) Y. O3 `" Q& F. V* ~. y
(normal, 3 to 90 ng/dL), androstenedione was 20
% y: L+ t4 C* _9 Cng/dL (normal, 18 to 80 ng/dL), dehydroepiandros-/ S& ^2 d4 ~# a2 i8 n
terone was 38 ng/dL (normal, 50 to 760 ng/dL),, J) }; G4 }2 M3 N  }6 q) }7 i; P
desoxycorticosterone was 4.3 ng/dL (normal, 7 to' {5 q% @* _% ]4 u: k3 W- e# F
49ng/dL), 11-desoxycortisol (specific compound S)3 ]0 ~0 |" I& ?3 x5 Y
was 43 ng/dL (normal, 10 to 156 ng/dL), serum cor-
( d5 G! ]  X1 U8 ?. r( P7 X% ?tisol was 7.6 µg/dL (normal, 2.8 to 23 µg/dL), total
$ g" C. O0 a2 ]testosterone was 60 ng/dL (normal <3 to 10 ng/dL),0 x" w" K6 x" L3 {) Z* @0 X
and β-human chorionic gonadotropin was less than
5 _; u8 b0 n- D5 mIU/mL (normal <5 mIU/mL). Serum follicular
! t* }4 K1 m& m% U8 o  m6 ustimulating hormone and leuteinizing hormone
% I9 |7 Z4 k+ l+ y* B, _concentrations were less than 0.05 mIU/mL
; L: W: n' l' f7 G/ ?7 f(prepubertal).
/ \* n3 v% V- O0 \The parents were notified about the laboratory/ I8 `. H, S5 ]+ w" e
results and were informed that all of the tests were: r! r8 Q0 p( U3 e  n% q# W  i
normal except the testosterone level was high. The
' B) v' i3 k& t, U2 ifollow-up visit was arranged within a few weeks to/ s8 P! B- I  j' c7 N8 {. C% |
obtain testicular and abdominal sonograms; how-# A6 E: \- B, B+ ?4 x% P+ R
ever, the family did not return for 4 months." A3 r) Q- q* |6 H% k- h- A
Physical examination at this time revealed that the
& z& O3 E4 i+ t# j5 m/ \child had grown 2.5 cm in 4 months and had gained2 b  l1 l0 P1 m. v. p1 m
2 kg of weight. Physical examination remained
& k: R6 q7 u5 Q; ~+ Nunchanged. Surprisingly, the pubic hair almost com-
' q( `% H7 L) x* h5 q3 Gpletely disappeared except for a few vellous hairs at
* f7 o/ L# t; r( ^the base of the phallus. Testicular volume was still 24 w; F8 ^5 }& i0 s3 V7 U1 s
mL, and the size of the penis remained unchanged.6 l& I4 o$ n% s, l' @* ^/ t% V
The mother also said that the boy was no longer hav-" ^: L! k* P' R) A! J& g! Z% r
ing frequent erections." n' q' U; [4 C- @
Both parents were again questioned about use of
2 I" I3 H3 C- {9 k3 u  V" Cany ointment/creams that they may have applied to
  V; p2 D, O# S# n. K/ E3 _2 z7 lthe child’s skin. This time the father admitted the
6 O( g# }% h* }7 I& ZTopical Testosterone Exposure / Bhowmick et al 541
7 ^8 ^) L; [* T6 n5 ~1 Kuse of testosterone gel twice daily that he was apply-. |" I2 n3 q) }9 n
ing over his own shoulders, chest, and back area for9 D! l% E* Q6 G; V- |* }
a year. The father also revealed he was embarrassed$ {: a/ M# t, U9 B3 J# p$ C* D+ U
to disclose that he was using a testosterone gel pre-( m3 q; a& p; H: G& R/ W
scribed by his family physician for decreased libido
5 j6 T; Y8 K& `secondary to depression.
& e+ x( u( k& d  A; W1 mThe child slept in the same bed with parents.1 b) V1 Y9 \5 r9 D- Z
The father would hug the baby and hold him on his
7 ?* d) O; T: `& fchest for a considerable period of time, causing sig-
. o" r- f- m/ X$ Dnificant bare skin contact between baby and father.4 }. |9 q! R7 H- R. [$ v7 I
The father also admitted that after the phone call,4 R- `% I1 V: C2 f
when he learned the testosterone level in the baby/ R: `# O1 t* Z5 R) I# B, b2 c
was high, he then read the product information
# v; @) h" k) kpacket and concluded that it was most likely the rea-$ _# X, N, W2 [# h! W$ w
son for the child’s virilization. At that time, they$ u3 U5 W- I: c
decided to put the baby in a separate bed, and the
" s/ M  k- c& \# Pfather was not hugging him with bare skin and had
8 ?- K' G8 h5 V# o" E- Dbeen using protective clothing. A repeat testosterone
& y+ X" |  i8 m4 d/ ?test was ordered, but the family did not go to the" I9 o  X3 x8 t' M* E/ J8 y/ L) R
laboratory to obtain the test.
: J9 g7 `. U; y$ `) T4 r* A# _Discussion! [7 h6 V( k9 q" |( Z- a2 r
Precocious puberty in boys is defined as secondary
1 }5 L7 b7 ?. q& esexual development before 9 years of age.1,4
( D- G: E) H9 `, UPrecocious puberty is termed as central (true) when' v1 \, K. p" v$ L
it is caused by the premature activation of hypo-
  x+ e& l0 M: \) fthalamic pituitary gonadal axis. CPP is more com-
6 G+ K: J& J& P) {# Fmon in girls than in boys.1,3 Most boys with CPP6 S5 G, y/ K' n7 W5 m
may have a central nervous system lesion that is/ J6 x' m2 d0 F7 }  Z) n
responsible for the early activation of the hypothal-6 d: l: K0 h% ?0 |
amic pituitary gonadal axis.1-3 Thus, greater empha-$ d$ X0 G! G- r1 c  Q
sis has been given to neuroradiologic imaging in
8 G+ W2 V4 K6 ]3 H7 u4 ~boys with precocious puberty. In addition to viril-
7 B# C- k  w+ A4 z7 v* T, Gization, the clinical hallmark of CPP is the symmet-
) m1 C$ r6 [$ ]' u) L% r3 i. urical testicular growth secondary to stimulation by- z0 c2 U2 d4 |. S
gonadotropins.1,3  T: I: ?  s( }. p% I+ X; N
Gonadotropin-independent peripheral preco-
& i  G$ e" z% B! Pcious puberty in boys also results from inappropriate
9 U! b' @: c) r+ u5 randrogenic stimulation from either endogenous or. P7 A2 N$ c. C6 Z9 c2 l# q& E
exogenous sources, nonpituitary gonadotropin stim-# v# X0 s  L+ A3 V' N( n5 {- R
ulation, and rare activating mutations.3 Virilizing
$ ?- ]: J  D/ Y8 r* \( j  jcongenital adrenal hyperplasia producing excessive6 w5 x0 G% ?( F
adrenal androgens is a common cause of precocious. c8 e% v4 C* o5 [8 H# O
puberty in boys.3,4
" v3 G0 P8 J2 c$ j5 `# F" a7 ?& YThe most common form of congenital adrenal* @% s& B0 ]6 W, w: \+ S  ?% q
hyperplasia is the 21-hydroxylase enzyme deficiency.
- }! K/ ~; F! G5 I) eThe 11-β hydroxylase deficiency may also result in
( k# [: r5 u( r' E2 R& d$ iexcessive adrenal androgen production, and rarely,5 B) f4 l3 B6 @2 |. |. M2 g
an adrenal tumor may also cause adrenal androgen
6 C! _/ U+ u% m/ |2 T* Xexcess.1,3
# X. u* w; q3 ]& s3 Qat University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from" B; W# F! N# c4 ^
542 Clinical Pediatrics / Vol. 46, No. 6, July 2007
1 ~1 \8 F* S* `A unique entity of male-limited gonadotropin-6 f: {7 Q# e& {9 y- K
independent precocious puberty, which is also known) |9 P9 p" |% i, z
as testotoxicosis, may cause precocious puberty at a
* x) c0 k, A6 |" rvery young age. The physical findings in these boys, `" r" F8 f4 {" ^
with this disorder are full pubertal development,( p& [4 y+ v8 S2 D$ g$ `
including bilateral testicular growth, similar to boys
3 y# l( P0 g* _with CPP. The gonadotropin levels in this disorder
, Y( g+ Z; h- k8 D+ f9 x% xare suppressed to prepubertal levels and do not show
% w- c* b1 f4 H1 q5 xpubertal response of gonadotropin after gonadotropin-% J, _& ~4 b2 v4 @7 D6 ~" x
releasing hormone stimulation. This is a sex-linked
! X8 w; _9 L) ]; c7 mautosomal dominant disorder that affects only
) X) h( `3 [) V4 _males; therefore, other male members of the family1 k& r# k- b- b0 O
may have similar precocious puberty.3; V6 `" ]6 J+ K
In our patient, physical examination was incon-8 A2 p3 T  u% v; M3 w1 t8 d5 s
sistent with true precocious puberty since his testi-
! J7 H* _  t) q% a* \+ |cles were prepubertal in size. However, testotoxicosis% O+ A9 W  n4 \* z9 H
was in the differential diagnosis because his father7 A% x6 |" o" `7 L% [
started puberty somewhat early, and occasionally,
: a# V" C" c1 x/ P  I, O! Q3 {* @1 Htesticular enlargement is not that evident in the, M/ q2 @3 R+ @, \# k# c6 X
beginning of this process.1 In the absence of a neg-
: S) Z: g1 A" P- f) ]- aative initial history of androgen exposure, our+ R8 t1 \/ e  |8 }& q
biggest concern was virilizing adrenal hyperplasia,0 j( o/ U# K# Z$ h+ {0 ?2 f. {
either 21-hydroxylase deficiency or 11-β hydroxylase
( T. o" ]# J$ a* vdeficiency. Those diagnoses were excluded by find-3 |% q  I1 m0 f# F# @5 _
ing the normal level of adrenal steroids.
& J8 s( K  O4 P8 e9 Q! yThe diagnosis of exogenous androgens was strongly
3 |, W3 y5 C' l5 V) U% e/ [suspected in a follow-up visit after 4 months because
) p, x+ S2 c3 c1 w( Bthe physical examination revealed the complete disap-
9 N" u1 e' l' u7 Q) Fpearance of pubic hair, normal growth velocity, and
( r: g) {4 B$ [3 T: @5 I' Gdecreased erections. The father admitted using a testos-
2 }8 E2 ?4 q5 _! kterone gel, which he concealed at first visit. He was
/ M  Y' d) f4 u1 e7 {' uusing it rather frequently, twice a day. The Physicians’
9 u, @. j3 ]. w' n4 oDesk Reference, or package insert of this product, gel or: I+ c  x9 `) ~
cream, cautions about dermal testosterone transfer to
( I0 Q6 W; }0 q$ O, u8 Xunprotected females through direct skin exposure.$ t" r4 Z% {/ c0 p) r! c2 s0 Y+ Y8 _
Serum testosterone level was found to be 2 times the
5 `4 d9 l' P( e+ ^4 Wbaseline value in those females who were exposed to) p+ e2 f8 ~: A0 ?) k
even 15 minutes of direct skin contact with their male/ l/ P0 u9 I2 ~: z+ }& s# a
partners.6 However, when a shirt covered the applica-
' r7 d  E4 W! Q6 A4 Xtion site, this testosterone transfer was prevented.3 `5 {6 A% ?8 g# A" N; N5 V! q
Our patient’s testosterone level was 60 ng/mL,  i' k; I1 T* ^3 H; |2 ?- b
which was clearly high. Some studies suggest that
$ C1 X8 c$ {% c7 h9 D% b5 i( i) `dermal conversion of testosterone to dihydrotestos-
8 i5 {2 J7 A$ b  Z1 _) T7 n/ hterone, which is a more potent metabolite, is more
5 q4 d4 y4 ]! c- ?( o  V& H5 \# n# {active in young children exposed to testosterone! y! w  n0 n" N* g
exogenously7; however, we did not measure a dihy-# {5 m+ r8 Y1 L5 H/ G
drotestosterone level in our patient. In addition to/ C+ G7 Q; Q) x, R. X
virilization, exposure to exogenous testosterone in
8 N/ h+ }) n" c% zchildren results in an increase in growth velocity and4 M1 O4 s. p/ c2 U4 R
advanced bone age, as seen in our patient.
, Q: {  u5 l; {8 n3 u' vThe long-term effect of androgen exposure during" _% l  x; d# @3 V0 P
early childhood on pubertal development and final
) t, ?8 K% P/ K2 A2 @- `9 |- C' yadult height are not fully known and always remain
, @. l- L: H0 O' T% A( Pa concern. Children treated with short-term testos-) \% o0 }2 y# ]2 o6 U! _8 D
terone injection or topical androgen may exhibit some, F6 D7 T6 k- o  J. \- U; T
acceleration of the skeletal maturation; however, after
+ r2 z: J+ g2 p; k0 Ecessation of treatment, the rate of bone maturation! G) c* e, U  Z9 Y: b/ W
decelerates and gradually returns to normal.8,9
, U" b7 E6 |5 U6 q9 u% lThere are conflicting reports and controversy
, a+ ~2 x1 s8 i) A8 _* f& A7 ^2 T9 pover the effect of early androgen exposure on adult
  ^+ z" Y& g  ^( |penile length.10,11 Some reports suggest subnormal
2 b+ ]! d8 J; e$ z% E$ kadult penile length, apparently because of downreg-
4 m) H1 d( R2 T* o  Kulation of androgen receptor number.10,12 However," `9 m! Y' {6 a! L# d+ i& Z+ r
Sutherland et al13 did not find a correlation between% ~# `) n8 F) h1 {8 n- t
childhood testosterone exposure and reduced adult# l8 y+ A5 T6 A* R( Q
penile length in clinical studies.
3 T5 U8 V0 x- I) O1 M& W" g" M+ `Nonetheless, we do not believe our patient is
' i$ c' P* L4 s0 |( y5 _1 q# sgoing to experience any of the untoward effects from
" k+ v/ o9 Z3 u! }$ g2 f' Htestosterone exposure as mentioned earlier because. U$ C" e0 c! w+ n! {6 c
the exposure was not for a prolonged period of time.
7 `8 ~: T' c0 j* mAlthough the bone age was advanced at the time of
. _5 E2 f, z& Y7 r4 I! x! e0 Mdiagnosis, the child had a normal growth velocity at. u  R; W0 I! E1 C  ^
the follow-up visit. It is hoped that his final adult
! \  o0 M6 I0 V8 X4 hheight will not be affected.
5 h4 @# z: n" H+ kAlthough rarely reported, the widespread avail-8 o. O0 L. T/ |7 ^3 q
ability of androgen products in our society may( A: V4 {3 E9 ]! `
indeed cause more virilization in male or female
" k0 s) l1 O* M2 \4 ?children than one would realize. Exposure to andro-
; p3 Q( ?* t  V/ c* `1 H8 F3 {, mgen products must be considered and specific ques-
1 M/ W" ?/ i$ Qtioning about the use of a testosterone product or
* F& H1 b* ~9 o% S1 ygel should be asked of the family members during; T" I, q& Q" y. Y5 x% _9 M& C
the evaluation of any children who present with vir-+ ]: K% b- s$ t# p2 j1 J$ j2 {7 P
ilization or peripheral precocious puberty. The diag-
! w# ]  s/ a6 x) mnosis can be established by just a few tests and by* T! I) f& L1 f2 s
appropriate history. The inability to obtain such a& y8 M- [* u* ?& l& L( p) V
history, or failure to ask the specific questions, may; c/ F: g# M; q: y
result in extensive, unnecessary, and expensive  ^( k% M  ^& N# m5 ?
investigation. The primary care physician should be
  t2 C& u9 u7 g3 n" X2 ^2 k3 gaware of this fact, because most of these children
. i. B9 D" L. @, S6 F: S. amay initially present in their practice. The Physicians’1 |; Q7 I2 I4 K. |9 W
Desk Reference and package insert should also put a
3 B' i, h2 R' h/ Vwarning about the virilizing effect on a male or
/ J4 _& M0 w* R) m; K" X$ yfemale child who might come in contact with some-4 S: \( K: L4 B4 h7 n
one using any of these products.
& R3 T; m/ D) u- cReferences
$ {: _- A( L8 h- w1. Styne DM. The testes: disorder of sexual differentiation, q2 P; p+ n# g8 C7 y( E
and puberty in the male. In: Sperling MA, ed. Pediatric: m2 h" U' M$ b7 U& S1 B
Endocrinology. 2nd ed. Philadelphia, PA: WB Saunders;
) x% |+ k( N$ I" b# L, `2002: 565-628.# E' q, @* j/ E7 {* z, F9 A) [
2. Rivarola M, Belgorosky A, Mendilaharzu H, et al. Precocious
1 r. a/ V5 Y4 w" {; r% |puberty in children with tumours of the suprasellar pineal0 ^* {  V$ f5 n- m/ ?! b
at University of Manchester Library on May 25, 2015 cpj.sagepub.com Downloaded from5 `% s# x, E7 k2 G* u, \
Topical Testosterone Exposure / Bhowmick et al 5436 W. P. g. P1 G7 H/ v
areas: organic central precocious puberty. Acta Paediatr.
4 D0 j' N- O6 i7 a( u! V. Q0 {" l2001;90:751-756.- T8 b8 ~8 z8 Z+ z
3. Lee PA. Puberty and its disorders. In: Lifshitz F, ed.$ P& j2 s4 k! G* R7 d# [- ^( t
Pediatric Endocrinology. 4th ed. New York, NY: Marcel) Z) e* u, N' v" b& @7 b# N) g
Dekker Inc; 2003:211-238.3 y* A* ^/ k6 O) T+ o& r
4. Yu YM, Punyasavatsu N, Elder D, D’Ercole AJ. Sexual3 n: O' [; [0 n% J" o/ o
development in a two-year-old boy induced by topical1 ^+ n  y7 F( P
exposure to testosterone. Pediatrics. 1999;104:e23.+ X+ \( g( [" V; [) M4 Q
5. Greulich WW, Pyle SI, eds. Radiographic Atlas of. J% I1 |; B5 y, T( v* C, a: R
Skeletal Development of the Hand and Wrist. 2nd ed.
0 o7 Y& A& b/ B+ A8 s* yStanford, CA: Stanford University Press; 1959.
1 Y  Z" ]# C4 }& {6. Physicians’ Desk Reference. Androgel 1% testosterone,2 w* u( c8 i! Y" o' h. p* o
Unimed Pharmaceutical Inc. Montvale, NJ: Medical+ y7 h" ]0 a0 m. A6 M2 G: W) ?4 Y
Economics Company, Inc; 2004:3239-3241.$ d8 c# S) _- t" V. d# k1 o  f
7. Klugo RC, Cerny JC. Response of micropenis to topical
5 A4 U8 U" ]; [) T& O. ^  Y; y$ Jtestosterone and gonadotropin. J Urol. 1978;119:
3 G& o2 ]  g* V2 p5 B3 F" B8 q8 Y  w4 B667-668.: A' h" E% Y) O9 q; Z1 c& \
8. Guthrie RD, Smith DW, Graham CB. Testosterone
) Y  w7 b; s9 Ctreatment for micropenis during early childhood. J Pediatr.
1 S1 @* y- }  r1973;83:247-252./ N0 g9 |% a: s# ^
9. Jacobs SC, Kaplan GW, Gittes RF. Topical testosterone9 u8 v9 @4 K9 H1 _/ c
therapy for penile growth. Urol. 1975;6:708-710.
8 i9 X1 _, T% `" Y: O10. Husmann DA, Cain MP. Microphallus: eventual phallic
! a2 H% k  l# }! S2 f$ r! wsize is dependent on the timing of androgen administra-9 y. N* E$ O& j  f' _( p/ [; b$ d
tion. J Urol. 1994;152:734-739.
; S. F+ e7 ?! }8 v8 {! k3 ]" k11. McMahon DR, Kramer SA, Husmann DA. Micropenis:6 I( H% c( E5 h  }
does early treatment with testosterone do more harm9 L! ]7 s. t7 x6 E2 |& P
than good? J Urol. 1995;154:825-829.) w9 S  o% n7 X7 m, r; e# U5 {
12. Takane KK, George FW, Wilson JD. Androgen receptor
% a+ \; P2 ~' e6 [  o( iof rat penis is down-regulated by androgen. Am J Physiol.
9 W$ ?) G+ o$ M! t$ e7 m1990;258:E46-E50.: z7 h0 F3 [4 {1 W
13. Sutherland RS, Kogan BA, Baskin LS, et al. The effect+ k; d/ y0 B1 Y1 {2 g% A3 j; s' V7 e
of prepubertal androgen exposure on adult penile
- j4 b; f- b* {8 v! ]3 q8 Dlength. 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