Virilism Epiphyseal

Epiphasic virilism *Differential diagnosis*

Some patients may have a “female” phenotype with clinical manifestations of virilism and the presence of additional features: moderate facial asymmetry, longer fingers and toes, hypertrichosis\*, gynecomastia in the absence of masculinized genitals and menstrual irregularities\*. In some cases, there may be signs of gonadal dysgenesis (partial or complete form of hermaphroditism).

Bilateral isotretinoin-sensitive dermatofibromas (benign fibrous histiocytoma) have been described in patients with Pellico syndrome, but there is no indication in the literature of their tendency to malignant transformation, which distinguishes them from giant atypical lipomatous dermatofibromas (see section 2.2).

It should be remembered that increased testicular fat and pseudohermaphrodity occur in 30% of cases of Marfan syndrome; this difference may lead to differential diagnosis with this disease. Inadequate determination of the secondary sex can worsen the prognosis and lead to insufficient correction of disorders. During the initial examination of boys, the presence of “female” clinical signs should be taken into account.