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

Hidrokortison Flourinef 1
10 mg/ BSA tablet 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