Premature pubarche: a non-benign clinical entity

Premature pubarche is the development of pubic hair without the development of other secondary sexual chacteristics before the age of 8 in girls. Traditionally, considered to be benign, premature pubarche has been associated with polycystic ovarian syndrome and the metabolic syndrome. This is the case of a 7-year-old female with warty lesions on the right thumb and labia majora, and an incidental finding tanner stage 2 pubic hair. 17-OHP and testosterone levels were normal, DHEAS level at the pubertal range. Her clinical profile places her at risk, and as such, monitoring is warranted for early detection of polycystic ovarian syndrome and metabolic syndrome in the future.

A case of 46, XY gonadal dysgenesis (Swyer syndrome) with yolk sac tumor

This is a case of a 23 years-old single, nulligravid with primary amenorrhea, sexual infantilism, tall stature who presented with abdominal enlargement. Ultrasound showed a small uterus, thin tall stature who presented with abdominal enlargement. Ultrasound showed a small uterus, thin endometrium, bilateral adnexal solid masses. Extensive diagnostic work-up for the etiology of the priamry amenorrhea led to the diagnosis of Swyer syndrome. Karyotyping showed 46, XY. On laparotomy, both gonads were solid with tumor implants on the omentum, mesentery and serosa of the small uterus. Total hysteroctomy with bilateral salpingo-gonadectomy, infracolic omentectomy, tumor debulking and biopsy of implants were done. Histopathologic report showed yolf sac (endodermal sinus tumor), both gonads and aforementioned implants. The risk of neoplasia in such cases is discussed.

Beyond the X's and Y's: A case of complete androgen insensitivity syndrome

The Sex or sexuality is very complex subject. From a biological standpoint, the appearance of the external genitalia is only one parameter. Complete androgen insensitivity syndrome (CAIS), the most common form of male pseudohermaphroditism, embodies the multifaceted nature of this concept. Patients usually present with 46, XY karyotype with bilateral testes, female external genitalia, a shortened vagina, absent or rudimentary mullerian derivatives, normal breast development, and absent or scant pubic and axillary hair, as was the case in the patient presented herein. Prevalence ranges from 1 :20,400 to 1 :62,400 births. Its management often requires a multidisciplinary approach. Aside from addressing health risks, the psychosexual, social and ethical aspects of this condition should also be dealt with.

A randomized controlled trial of evening primrose oil for cervical priming prior to operative hysterroscopy

Objective: The purpose of this study was to determine the efficacy of Evening Primrose Oil as a cervical ripening agent when used prior to operative hysteroscopy. Study Design: A randomized, double-blind, placebo-controlled trial included a total of 42 patients randomly assigned to the Evening Primrose Oil group (24) and to the placebo group (18). The primary outcome was initial cervical dilatation prior to hysteroscopy. The number of patients requiring cervical dilatation and duration of cervical dilatation to Hegar dilator size 10 were included as secondary outcomes. Results: There was a statistical and clinically significant difference between the initial cervical dilatation in the treatment and placebo groups (7.81 mm vs. 4.33mm). All patients in the placebo group required cervical dilatation prior to hysteroscopy while only 47.62 percent of patients in the treatment group required any dilatation. It took an average of 53.56 seconds to dilate the cervix to Hegar size 10 in the placebo group compared to 17.43 seconds in the treatment group. Conclusion: Similar to trials in pregnant patients, this study proved that Evening Primrose Oil can be used as a cervical priming agent prior to gynecologic procedures.

Androgen insensitivity syndrome: X plus Y equals intersex

A case of Partial Androgen Insensitivity Syndrome in a 21 year old woman who underwent bilateral gonadectomy and postoperative estrogen therapy is presented.