Case report

a 3 week old baby

with Disorder of Sex
Development
IDENTITY :

Name : A

Age : 3 weeks old

Adress : Central Java

History Taking :
A 3 week old baby was administered from district hospital due to
genital ambiguity

The baby was born from G1P1A0, 22 years old mother, aterm
pregnancy, previous gestational illness was denied. Regular ANC visites
to midwife and obstetrician (>4x).

The baby was delivered with SC by obstetrician, crying immediately,

birth of weight 3100 gram.
Infant male gender is expressed by a pediatrician and already have a
birth certificate with male gender
Physical Examination
weight : 3,2 Kg
HR : 137x/mnt RR: 33x/mnt t: 36,8C
general condition : conscious, less active, spontaneous breathing (+),
Head :no dismorfic face, no hypertelorism, no macroglosia
Thorax : symmetrical, normal breathing sound and heart sound
Abdomen, normal bowel sounds, and no enlargement found in spleen and
liver
warm in acral extremities (+) and capillary refill <2
No simian crease at extremities

Laboratory Examinations USG Abdomen

Impression :There are no testicles
Hb : 11.7 gr% GDS : 101mg/dl and tubular structures in the
Ht : 32.2 % Ureum : 52 mg/dl posterior bladder that are likely
Lekocyte : 16700 /UL Creatinin : 0,29 mg/dl uterus
Platelets : 514300/UL Cortisol pagi 1,43 g/dl
Sodium : 135 mmol/l 17-OHP 351,2 nmol/L
Potassium : 5.6 mmol/l Testosteron 0,65 ng/ml
Chloride : 95 mmol/l Progesteron 21,10 ng/ml
Calcium : 2.2 mmol/l
Treatment :

Hidrokortison Flourinef 1 tablet

10 mg/ BSA daily

NaCl 1,5 gr
/12 hours
The parents are concerned regarding to :

Shoud the baby be operated for gender determination?

Will the baby sociable with male/ female peers?

Should the medication for a long life treatment?

Will the baby have offspring in the future?

How to take care of changes in birth certificate ?

How to explain it to the whole big family ?
Thank you