PEDIATRICS Vol. 64 No. 5 November 1979, pp. 609-612
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Elevated Free Testosterone in an Obese, Hirsute Premenarchial Girl: Effects of Norethynodrel and Mestranol

Morey W. Haymond MD1, Yvonne Bussmann MD1, and Walter G. Wiest PhD1

1 Edward Mallinckrodt Department of Pediatrics, Division of Endocrinology and Metabolism, and Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis

An 11-year-old premenarchial girl who demonstrated the clinical and biochemical abnormalities of the Stein-Leventhal syndrome is reported. Although the concentration of total circulating testosterone was within normal limits, levels of free testosterone and testosterone-estradiol-binding globulin (12.9 to 22.7 pg/ml and 7.9 to 11 x 10-9 moles/liter, respectively) were markedly different from those of prepubertal girls (1.1 ± 0.9 pg/ml and 102 ± 27 x 10-9 moles/liter, mean ± 1 SD) and normal women (4.3 ± 1.2 pg/ml and 82 ± 30 x 10-9 moles/liter). Luteinizing hormone but not follicle-stimulating hormone concentrations were increased. In the absence of abnormal adrenal steroid excretion or response to dexamethasone suppression and with a clear biochemical response to oral contraceptives (decreased levels of luteinizing hormone and free testosterone and increased concentrations of testosterone-estradiol-binding globulin), this patient closely resembles older individuals with the Stein-Leventhal syndrome. Therefore, the measurement of testosterone-estradiol-binding globulin and free testosterone may be useful in the laboratory evaluation of any adolescent girl in whom no other cause for hirsutism can be identified.

Submitted on January 15, 1979
Accepted on February 15, 1979