Levonorgestrel
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Congenital virilization of the external genitalia: 4 case reports In a case series, four female neonates were described, who developed congenital virilization of the external genitalia following an in-utero exposure to maternal levonorgestrel intrauterine device [dosages and duration of treatments to reactions onsets not stated]. Patient 1: A female neonate was born at term without additional pregnancy complications. Prior to pregnancy, the mother of the infant had undergone placement of levonorgestrel intra-uterine device (IUD) [Mirena]. Within one month of IUD placement, the mother had became pregnant. At 4 month of age, the female infant presented with genital virilization. Clinical examination showed posterior labial fusion without rugation, normal clitoris, urogenital sinus (UGS), long perineal body and orthotopic anus. She had 46,XX karyotype. Imaging showed normal Mullerian structures, right multicystic dysplastic kidney (MCDK), normal left kidney and normal voiding cystourethrogram (VCUG). Laboratory test showed dehydroepiandrosterone (DHEA) and 17-OH pregnenolone within normal limits, which confirmed absence of congenital adrenal hyperplasia. Examination under anaesthesia showed UG 1.5cm, normal vagina, cervix, bladder, ureteral orifices and urethra. At the age of 9 months, flap vaginoplasty was performed without complications and with good cosmetic outcomes. Patient 2: A female was born at term without additional pregnancy complications. Prior to pregnancy, the mother of the infant had undergone placement of levonorgestrel IUD [Mirena]. After 2 years of IUD placement, the mother had became pregnant. At 4 month of age, the female infant presented with genital virilization. Clinical examination showed posterior labial fusion without rugation, mild clitoral enlargement, UGS, long perineal body and orthotopic anus. She had 46,XX karyotype. Imaging showed normal Mullerian structures and normal kidneys. 17-OH pregnenolone within normal limits, which confirmed absence of congenital adrenal hyperplasia. Examination under anaesthesia showed UG 1cm, normal vagina, cervix, bladder, ureteral orifices and urethra. At the age of 2 year, flap vaginoplasty was performed without complications and with good cosmetic outcomes. Patient 3: A female was born at term without additional pregnancy complications. Prior to pregnancy, the mother of the infant had undergone placement of levonorgestrel IUD [Mirena]. Within a few days of IUD placement, the mother had became pregnant. At 31 month of age, the female child presented with genital virilization. Clinical examination showed posterior labial fusion without rugation, normal clitoris, UGS, long perineal body and orthotopic anus. She had 46,XX karyotype. Imaging showed normal Mullerian structures and normal kidneys. Laboratory test showed androstenedione, deoxycorticosterone, DHEA, 11-deoxycortisol, 17-OH progenolone and 17-OH progesterone within normal limits, which confirmed absence of congenital adrenal hyperplasia. Examination under anaesthesia showed UG less than 2mm, n
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