Clinical_Rounds_in_Endocrinology_Volume_II_-_Pediatric_Endocrinology

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ab

c

Fig. 7.22 (a) An 18-year-old boy presented with poor virilization and (b) gynecomastia; (c) his
testicular volume was 12 ml with serum testosterone of 4 nmol/L suggestive of partial hypogo-
nadotropic hypogonadism

91. What are the disorders to be considered in a well-virilized male with bilateral
    nonpalpable testes?
    A well-virilized male with bilateral nonpalpable testes who is not on androgen
    replacement therapy suggests the diagnosis of idiopathic bilateral cryptorchi-
    dism. Testosterone production by the Leydig cells remains uninterrupted as
    Leydig cells are heat-resistant, whereas germ cells get atrophied as they are
    heat-sensitive. In addition 46,XX CAH with severe virilization (Prader 5) mani-
    fests apparently as virilized male with bilateral nonpalpable testes. Further,
    patients with hypogonadism of any etiology with bilateral nonpalpable testes

7 Delayed Puberty