Complete testicular feminization in a patient in whom vaginal smears for estrogen and urinary total estrogen did not differ for 41/2 months after gonadectomy is reported. Evaluation at 101/2, 18, and 24 months after castration did show an eventual decline in estrogen production. These findings and a review of the literature suggest that the adrenal gland may play a significant role in the production of estrogen in patients with testicular feminization, but only under the influence of the gonads. Adrenal hyperfunction may be a secondary factor in the pathophysiology of the syndrome. Urinary 17-ketosteroid levels were elevated before operation. A precipitous and sustained drop in 17-ketosteroids occurred after gonadectomy. Androsterone was markedly elevated in urinary fractionation of 17-ketosteroids before gonadectomy.
© 1970 The American College of Obstetricians and Gynecologists