Microphallus Follow-up

Updated: Feb 20, 2017
  • Author: Karen S Vogt, MD; Chief Editor: Sasigarn A Bowden, MD  more...
  • Print
Follow-up

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.

Next:

Further Inpatient Care

In the newborn nursery, any infant with microphallus should be closely monitored for hypoglycemia. Hypoglycemia should prompt evaluation for other pituitary hormone deficiencies.

Previous
Next:

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. [2, 14]

Prognosis is much more guarded in children with androgen insensitivity, especially with significant genital ambiguity.

Mortality/morbidity

When micropenis is associated with hypopituitarism and hypoadrenalism, the infant can develop hypoglycemia, electrolyte abnormalities, hypotension, and shock. Infants with midline defects and those with optic nerve hypoplasia or aplasia deserve particular attention because these defects can be associated with pituitary hormone deficiencies. Failure to recognize this association in an ill neonate can result in death. Infants who survive the newborn period may exhibit varying degrees of poor growth and failure to thrive, depending on potential associated hormone deficiencies or genetic syndrome.

Psychosocial concerns can arise over issues such as gender identity, normal standing urination, physical appearance, and sexual performance. These concerns should be addressed with early evaluation, treatment and counseling, if appropriate.

In cases of extreme micropenis, especially if associated with other genital anomalies (eg, cryptorchidism, hypospadias), gender reassignment is sometimes considered. However, the family should be intimately involved in this decision, and counseling from a center with a multidisciplinary team skilled at gender reassignment should be pursued.

Previous
Next:

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, the parents should play a key role in the decision process.

Previous