Serum total testosterone levels in a patient with late onset 21-hydroxylase deficiency and a twin gestation.

OBJECTIVE

To present serum androgen levels during pregnancy in a twin gestation complicated by maternal late onset 21-hydroxylase deficiency.

DESIGN

Case report.

SETTING

University teaching hospital reproductive endocrinology and infertility practice.

PATIENT(S): A 27-year-old with nonclassic 21-hydroxylase deficiency and infertility, twin female fetuses, and elevated androgens.

INTERVENTION(S): Steroid replacement.

MAIN OUTCOME MEASURE(S): Serum T and 17-hydroxyprogesterone (17-OHP) levels.

RESULT(S): Elevated androgen levels persisted throughout pregnancy in spite of aggressive steroid replacement. However, twin girls were born without any evidence of virilization.

CONCLUSION(S): The changes associated with a twin gestation may result in excessive stimulation of androgens in mothers with nonclassic 21-hydroxylase deficiency. However, the increased placental aromatase provides protection.