eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Microphallus: Follow-up

Author: Karen S Vogt, MD, Pediatric Endocrinologist, Department of Pediatrics, Division of Endocrinology, Walter Reed Army Medical Center
Coauthor(s): Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences; Andrew J Bauer, MD, Program Director, Department of Pediatrics, Division of Pediatric Endocrinology, Uniformed Services University of the Health Sciences; Michael J Bourgeois, MD, Director of Pediatric Undergraduate Medical Education, Associate Professor, Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Texas Tech University School of Medicine
Contributor Information and Disclosures

Updated: Jul 9, 2008

Follow-up

Further Inpatient Care

  • In the newborn nursery, any infant with microphallus should be closely monitored for hypoglycemia.

Further Outpatient Care

  • Monitor infants with isolated micropenis for subsequent growth and development problems. If any problems arise, evaluate and treat appropriately.
  • Many children with micropenis, especially those with gonadotropin deficiency, do not have spontaneous or complete puberty. In these cases, testosterone is used to initiate puberty, with the dosage gradually increased to an adult replacement dose in a manner that mimics natural puberty.
  • In those with hypogonadotropic hypogonadism who desire fertility, hCG and recombinant FSH can be given to promote testosterone secretion and spermatogenesis at the appropriate time by a specialist in reproductive medicine.
  • Appropriate counseling should be provided.

Prognosis

  • The prognosis of boys with micropenis secondary to gonadotropin or testosterone deficiency is usually good. These individuals generally respond well to testosterone therapy and function normally as adults. However, despite the potential for near-normal adult phallic size and sensitivity, infertility is generally expected.
  • Prognosis is much more guarded in children with androgen insensitivity, especially with significant genital ambiguity

Patient Education

  • Provide parents with a clear picture of the cause of their child's problems, including expectations from treatment. In situations in which gender assignment is being contemplated, include the parents in the decision process.

Miscellaneous

Medicolegal Pitfalls

  • The importance of appropriate gender assignment cannot be overemphasized.
  • Evaluate any genital abnormality carefully and early on, using appropriate consultations.
    • Girls with congenital adrenal hyperplasia have been labeled boys prematurely based on the appearance of their genitalia.
    • Some males have been gender assigned as girls and put through genital surgery when androgen therapy may have been a simpler and more appropriate treatment.
 


More on Microphallus

Overview: Microphallus
Differential Diagnoses & Workup: Microphallus
Treatment & Medication: Microphallus
Follow-up: Microphallus
References
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References

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Further Reading

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Keywords

microphallus, micropenis, ambiguous genitalia, hypospadia, small genitalia, growth hormone deficiency, small penis, tiny penis, absent penis, 5-alpha reductase deficiency, partial androgen insensitivity syndrome, Prader-Willi syndrome, Klinefelter syndrome, Noonan syndrome, hypopituitarism, hypoadrenalism, electrolyte abnormalities, hypotension, shock, gender identity, cryptorchidism, gender reassignment, clitoromegaly, neonatal hypoglycemia, Kallman syndrome, adrenal insufficiency, cleft lip, cleft palate, midfacial hypoplasia, hypogonadotropic hypogonadism, congenital heart disease, renal agenesis, sensorineural deafness, visual abnormalities, synkinesia, septum pellucidum, optic nerve hypoplasia, septo-optic dysplasia, SOD, testicular degeneration, tall stature, gynecomastia, small firm testes, increased leg length, short stature, end-stage renal disease, hepatic fibrosis, hearing loss, Bardet-Biedl syndrome, CHARGE syndrome, Robinow syndrome, Rud syndrome

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Contributor Information and Disclosures

Author

Karen S Vogt, MD, Pediatric Endocrinologist, Department of Pediatrics, Division of Endocrinology, Walter Reed Army Medical Center
Karen S Vogt, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Andrew J Bauer, MD, Program Director, Department of Pediatrics, Division of Pediatric Endocrinology, Uniformed Services University of the Health Sciences
Andrew J Bauer, MD is a member of the following medical societies: American Academy of Pediatrics, American Thyroid Association, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Michael J Bourgeois, MD, Director of Pediatric Undergraduate Medical Education, Associate Professor, Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Texas Tech University School of Medicine
Michael J Bourgeois, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Arlan L Rosenbloom, MD, Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology
Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Florida Pediatric Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

George P Chrousos, MD, FAAP, MACP, MACE, Professor and Chair, Department of Pediatrics, Athens University Medical School
George P Chrousos, MD, FAAP, MACP, MACE is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfiser, Inc. Honoraria Consulting

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