Surgical implications of pediatric endocrine disorders.

The adrenal gland and the gonads both originate in the embryonic posterior mesenchyme and secrete steroids. Malfunction in either of them results in certain typical developmental problems. The adrenogenital syndrome resulting from excess androgen production occurs as masculinization in the female and precocious maturation in the male. Adrenal tumor usually has the same presentation; feminizing tumors are rare and usually are malignant. Gonadal problems include enlargement of sex organs, ambiguous genitalia, missing testes, and tumor causing precocious puberty. Endocrine problems must be assessed as early as quickly as possible, particularly cases of ambiguous genitalia, so that a proper sex assignment can be made and treatment instituted before parental attitudes arise that will affect the child later on. Surgical restructuring or removal of unneeded organs often is necessary.