We describe a 4 year-old Afro-American male who presented with significant virilization, accelerated growth, and aggressive behavior of 1-2 years duration. Physical exam was remarkable for a height age of 6 years, skeletal age of 7.5 years, muscular body habitus, Tanner II pubic hair, and Tanner III genitalia, but prepubertal size testes. No source of exogenous androgen exposure was identified. Initial evaluation revealed prepubertal levels of gonadal and adrenal androgens (Table), normal ACTH-stimulated levels of adrenal steroids, undetectable levels of gonadotropins and β-hCG, and a negative routine urine steroid metabolite analysis. The child was admitted to the clinical research center for 24 h every 20 minute blood sampling to identify intermittent androgen secretion, a 24 h urine collection for detection of 39 unusual androgen metabolites by gas chromatography/mass spectometry, and a scrotal skin biopsy for qualitative and quantitative androgen receptor analysis. All were normal. Five months after initial evaluation the child underwent spontaneous resolution of symptoms. Growth slowed to an age-appropriate rate, skeletal maturation normalized, the pubic hair fell out, and the aggressive behavior ceased. We postulate a self-limited process of androgen production which apparently became quiescent during the course of our evaluation. The mechanism of such a process has not been previously described.

Table 1
Full size table