[Heterosexual precocious puberty due to arrhenoblastoma. Postsurgical spontaneous pregnancy]. / Pubertad precoz heterosexual por arrenoblastoma: embarazo espontáneo postescisión.

ABSTRACT

It is presented the case of a female with heterosexual precocious puberty associated to hyperandrogenism and virilization due to arrhenoblastoma, who became pregnant after surgery. Clinical study a 14-year-old female initiated at age 6 years with premature pubarche and telarche. By age 11, the patient only had one menstrual period along with virilization. Physical exam disclosed facial acne, cricoid enlargement, breast Tanner II, pubic hair Tanner III, clitoromegaly of 4.5 cm and hypotrophy of labia majora. Ferriman and Gallwey 12. Basal quantitation of circulating testosterone 1.25 ng/mL (normal 0.2 to 0.8 ng/mL), androstenedione 13.9 ng/mL (normal 0.5 to 2.4 ng/mL). A pelvic ultrasonographic study showed uterus of 66 x 25 x 30 mm, right ovary of 50 x 50 mm, hyperechoic with echolucid and nodular areas (vol. 65.3 cc). Left ovary was of 30 x 30 mm with echolucid areas of 2.0 mm (vol. 5.1 cc). Cariotype 46XX. Surgical right oophorectomy was performed containing an ovoid tumor of 4 x 3 x 3 cm. Histologic analysis revealed a Sertoli Leydig (Type II, Mayoer) cell tumor. The patient resumed menses and became pregnant at age 20 (22 week obitus). In the last assessment, performed 6 years after surgery, the patient resumed normal menses, Ferriman and Gallwey 5, Tanner V and regression of clitoromegaly to 3.0 cm. In this case, surgery provided remission of hyperandrogenism, normal menstrual cycles and fertility restoration.