Clitoromegaly: A Case Report and Literature Review

R. S. Iwo-Amah *

Department of Obstetrics and Gynecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

F. C. C. Wekere

Department of Obstetrics and Gynecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

R. Iheagwam

Department of Obstetrics and Gynecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

N. Inimgba

Pamo University of Medical Sciences, Port Harcourt, Nigeria.

S. C. Amadi

Department of Obstetrics and Gynecology, Rivers State University Teaching Hospital, Port-Harcourt, Nigeria.

*Author to whom correspondence should be addressed.


Abstract

Background: Clitoromegaly is an abnormally large clitoris. The clitoris develops from the genital tubercle in the female and forms the penis in the male. It could be congenital or acquired. When seen in newborns, it’s likely cause is Congenital Adrenal Hyperplasia (CAH) and this condition is secondary to enzyme deficiency -21 hydroxylase deficiency or 11Beta hydroxylase deficiency. Patients with clitoromegaly are usually associated with infertility, because of the high circulating androgens.

Aim: To highlight the presence of clitoromegaly in a pregnant woman, with no history of difficulty in achieving pregnancy.

Case Presentation: The case report was that of a 37 years old Gravida 4, Para 1+2 who was admitted for cervical cerclage insertion due to previous recurrent mid-trimester miscarriages. Clitoromegaly was observed in theatre as an incidental finding.

Results: Investigation results were karyotype 46XX, Normal Uterus, fallopian tubes and ovaries. The cervix was short with funnelling of the Internal Cervical OS. Cortisol level was low and Testosterone level was minimally high. ACTH stimulation test noted adrenal hyperplasia. 21 hydroxylase deficiency was Non-Classical CAH. This is a mild form of Congenital Adrenal Hyperplasia. Patients usually may or may not present with symptoms.

Conclusion: This is a case presentation of a patient with clitoromegaly, with investigation results showing a mild form of adrenal hyperplasia. Infertility was not a problem, as patients had conceived four times. The small penis-like structure of her clitoris was also not a problem for her.

Keywords: Clitoromegaly, adrenal hyperplasia, 21- hydroxylase deficiency, androgens


How to Cite

Iwo-Amah, R. S., Wekere , F. C. C., Iheagwam , R., Inimgba , N., & Amadi , S. C. (2023). Clitoromegaly: A Case Report and Literature Review. International Journal of Research and Reports in Gynaecology, 6(1), 37–42. Retrieved from https://journalijrrgy.com/index.php/IJRRGY/article/view/82

Downloads

Download data is not yet available.

References

Jarret OO, Ayoola OO, Jonsson B, Albertson-Wikland K, Ritzen EM. Country based reference values and international comparisons of clitoral size in healthy nigerian newborn infants. Acta Paediatr. 2015;104:1286-1290.

Mohammed AT, Imad Ziouziou. Congenital clitoromegaly in an adult. Pan African Med-Journal PAMJ. 2019;34:141.

Pai W, Tseng HI, Lu CC, Chen HL. Ambiguous genitalia during neonatal period: A 15 years’ experience at a medical center. Clin Neonatal 2007;14:65-68.

Parappil H, Rahman S, Al KF. Virilization in a female neonate due to increased maternal androgens. Qatar Med J. 2009; 18:74-76.

Kim KS, Kim J. Disorders of sex development. Korean J Urol. 2012;53: 1-8.

Dumont T, Black AY, Ahmet A, FlemingNA: Isolated transient neonatal clitoromegaly with hyper androgenism of unknown etiology. J Pediatr. Adolesc Gynecol 22. 2009;e142-145.

Manta Gupta, Vandana Saini, Anju Poddar, Supriya Kumari. Acquired clitoromegaly: A gynecological problem or an obstetric complication. J Clin Diagn Res. 2016 Dec;10(12):QD10-QD11.

Elhomsy G, Griffing GT. Dehydroepiandro-stenedione (DHEA) sulphate. Chief editor Eric B Stares. Medscape.com; 2014.

Tagatz GE, Kopher RA, Nagel TC, Okagaki T. The clitoral index: A bioassay of androgenic stimulation. Obstet Gynecol. 1979;54(5):562-64.

Dhande A, Chougle QA, Lal V, Gupta S, Dhande K. Neurofibroma presenting as clitoromegaly. Int J Res Med Sci. 2015; 3(12):3887-88.

Kumar S, Agrawal S, Jayant K, Shankargowda SA. Large clitoral leiomyoma in a 42-Year-old premenopausal woman. Nephrourol Mon. 2014;6(3):e17022. Published online 2014 May 12.

A Padmaja, Chitranshi A. Idiopathic acquired clitoromegaly: A case report. RCOG World congress 2014; poster ID 1211.

Azurah AG, Grover S, Mcgregor D. plexiform schwannoma of the clitoris in a young girl: A case report. J of Reprod Medicine. 2013;58(7-8):365-68.

Gomes AL, Onofre LS, Leão JQ de Souza, Leão FG, Cruz TMA, Sircilli MHP, et al. Clitoral anomalies not associated with disorders of sex development. Journal of Pediatric Surgery Case Reports. 2013;1(11):403-05.

Singh A, Chitragar SS, Dadhwal V, Jindal VL, Sharma AK, Suri V, et al. Vascular hamartoma: an unusual cause of clitoromegaly in an 18-year-old patient. Low Genit Tract Dis. 2012;16(3):325-27.

Gazic B, Sramek-Zatler S, Repse-Fokter A, Pizem J. Pilomatrix carcinoma of the clitoris. Int J Surg Pathol. 2011;19(6): 827-30.

Maor-Sagie E, Arbell D, Prus D, Israel E, Benshushan A. Pilonidal cyst involving the clitoris in an 8 year old girl – A case report and literature review. J Pediatr Surg.2010; 45:e27-e29.

Mandal S, Dhingra K, Gupta P, Khurana N. Acquired (idiopathic) intradermal nevus with junctional activity presenting as clitoromegaly in a child: Report of a case. Eur J Pediatr. 2009;168(11):1405-07.

Al-Tonbary Y, Zalata K, Sarhan M, El-Ashery R, Fouda A. Rhabdomyosarcoma of the clitoris. Hematol Oncol Stem Cel Ther. 2008;1(2):133–35.

Koussidis GA. Gynecologic rarities: A case of periclitoral abscess and review of the literature. AJOG. 2012;207(5):e3-e5.

Karatayli R, Gezginc K, Gok D, Akar A. A rare cause of recurrent vulvar pain: Case presentation of periclitoral abscess. Gynecol Obstet Reprod Med.2012;i8: 166-67.

Bedoya-Ronga A. Periclitoral abscess, an uncommon gynaecological problem. RCOG World congress. 2013 EP11.04.

Rouzi AA. Epidermal clitoral inclusion cysts: Not a rare complication of female genital mutilation. Hum Reprod. 2010; 25(7):1672-74.