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The male adolescent may present several endocrinological problems, the most frequent of which is the retardation or absence of puberty due to constitutional delay of growth and development. This form does not require therapy and must be distinguished from other forms of hypogonadism (primitive or secondary) by endocrine tests (LHRH test, nightly pulses LH secretion, plasmatic basal level of testosterone and after HCG, cerebral NMR). Hypogonadism treatment consists of replacement therapy with testosterone or testes stimulation with HCG or LHRH. Another frequent disease is gynecomastia, usually due to physiological enlargement of mammary gland during pubertal development, sometimes it may be secondary to hypogonadism, tumors, liver function abnormalities. Severe or psychologically disturbing gynecomastia can be corrected by reductive mammoplasty. Very often, adolescents may present diseases related to incorrect food habits. Obesity is common and anorexia is becoming an important problem also in males.

The male adolescent may present several endocrinological problems, the most frequent of which is the retardation or absence of puberty due to constitutional delay of growth and development. This form does not require therapy and must be distinguished from other forms of hypogonadism (primitive or secondary) by endocrine tests (LHRH test, nightly pulses LH secretion, plasmatic basal level of testosterone and after HCG, cerebral NMR). Hypogonadism treatment consists of replacement therapy with testosterone or testes stimulation with HCG or LHRH. Another frequent disease is gynecomastia, usually due to physiological enlargement of mammary gland during pubertal development, sometimes it may be secondary to hypogonadism, tumors, liver function abnormalities. Severe or psychologically disturbing gynecomastia can be corrected by reductive mammoplasty. Very often, adolescents may present diseases related to incorrect food habits. Obesity is common and anorexia is becoming an important problem also in males.

Neonatal screening of congenital hypothyroidism has been recently extended to the most of North America, Australia, Europe, and to several Italian areas. Before screening programs, several Authors reported neurological defects and behavioral disturbances also in patients whose treatment has been precocious, thus stressing the importance of an antenatal thyroidal defect. We have therefore setted up a follow-up program to evaluate the prevalence and to treat such disturbances in hypothyroid children. In this report we describe the program, present the most significant preliminary data and discuss the prognosis of hypothyroid patients detected by screening programs.

Considering the overcoming importance that cholesterol levels and lipoprotein pattern presents as atherosclerosis risk factor, the Authors have performed lipoprotein analysis in two groups of obese children (weight excess over 50% of the ideal weight). The patients were hospitalized and treated by dietetic therapy and moderate exercise for 15 days. In group 1 the diet was daily supplemented by fibres. In both groups a weight drop as well as reduction of total cholesterol and LDL cholesterol was observed, while serum triglycerides and VLDL cholesterol and HDL cholesterol remain substantially unchanged.

A female patient affected by congenital adrenal hyperplasia, has been brought up as a male till five and half year old. After exact diagnosis has been made, a complete psychological evaluation has suggested the possibility of a change in the rearing sex. We briefly summarize the psychological, medical, legal aspects of this late sexual reattribution. After a five-years follow up, results may be considered satisfactory.

After a brief recall of male sexual differentiation, main features of different etiopathogenetic forms conditioning male pseudohermaphroditism (MPSH) are considered. Procedures for an early and exact identification are illustrated in order to formulate an appropriate prognosis. Hormonal treatment and corrective surgery are discussed; in case of severe malformations, a gender reassignment may be evaluated.

Growth patterns of eleven male subjects affected by congenital adrenal hyperplasia (CAH) due to 21 hydroxylase deficiency were studied and correlation with treatment was evaluated. All patients had completed their growth and were divided into two groups according to the age of diagnosis; group A: treated before 6 months of age (5 patients), group B: treated after 3 years of age (6 patients). Besides the pattern of growth, mean parental age, genetic target, onset and completion of puberty were considered. Regardless of the age at diagnosis, the patients of both groups had an anticipated and stunted final height vs. general population, but correlated with mean parental height. In all patients pubertal spurt failed and height velocity slowed down after twelve years of age. We conclude that pattern of growth of patients with CAH is deeply influenced by genetic and constitutional factors and by negative effects of glucocorticoid therapy. Actually an excellent glucocorticoid treatment of CAH is not available as yet and careful clinical and laboratory evaluations are necessary to minimize negative influences on growth.

Recently new advances are achieved in the diagnosis of CAH, by discovering clinical forms different from the classical one: the late-onset and the cryptic-CAH. While the diagnosis of classical form mainly depends on dosing 17-OH-progesterone levels in all newborns, the detection of non-classical form requires measurement of adrenal steroids in basal conditions and after ACTH stimulation. The Authors recommend a careful follow-up of treated patients by frequent clinical and hormonal evaluations in order to prevent slightly unsuitable therapy that could compromise the achievement of adequate adult height. It is necessary to evaluate not only the daily total amount, but also the pattern of administration and which adrenal preparation is preferable.

Testicular hormones, produced by hypothalamic-pituitary-gonadal axis activation, induce male development during embryogenesis and sexual maturation at puberty. As a consequence, any lesion at different levels of the axis is responsible for different clinical alterations, depending on the phase of life in which it develops, from early gestation to adult life. The evaluation of a hypogonadic male is complex and often diagnostic procedures only discriminate the level of damage but not the cause. Standardized and widely accepted therapies for specific forms of hypogonadism are briefly exposed. Three cases of hypogonadotropic hypogonadism are reported.

Real-time ultrasonography of pelvic organs is a useful tool in diagnosing disorders in sexual development. US has proved to be rapid, accurate, non invasive method to visualize normal and pathologic pelvic structures and its role in intersex disorders lies in the capacity of demonstrate the anatomy of the genital and urinary tracts. The sonographic finding of feminine internal genitalia and bilateral enlargement of the adrenal glands in a newborn is suggestive for congenital adrenal hyperplasia (CAH) and allows to prevent the symptoms of a salt-losing syndrome.