Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Severe Acute Respiratory Syndrome Sex Differentiation Disorders 1335

General measures

Admit to isolation in negative pressure room, contact precautions and

N95 masks on entering. Prepare for full respiratory support, seek con-

sultation with infectious diseases and CDC

specific therapy

Treatment Options

■No specific treatment available. Ribavirin shown to be of no benefit.

follow-up

■Supportive care as needed

complications and prognosis

■High morbidity and mortality. Worse prognosis with age, comorbid

conditions, elevated LDH on admission, atypical symptoms.

SEX DIFFERENTIATION DISORDERS

KIRK NEELY, MD

history & physical

History

■Exposure to androgens or teratogens

■Family history of genital ambiguity, hypospadias, delayed puberty

■Delayed puberty:

➣Females: no breast tissue by age 13 y

➣Males: no testicular enlargement by age 14 y

■Amenorrhea, virilization, infertility

➣Primary amenorrhea: no menarche by age 16 y

➣Secondary amenorrhea: fewer than 2 menstrual cycles/y after

normal menses

Signs & Symptoms

■Ambiguity of external genitalia:

➣Incomplete or excessive midline fusion from fetal androgen ex-

posure

➣Inappropriate phallic size

■Virilized female:

➣Complete labial fusion or posterior fusion

➣Single urogenital orifice

➣Clitoromegaly

➣Labioscrotal rugation, pigmentation