Challenges, Clinical and Laboratory Profile of Children Referred for Micropenis at a Nigerian Tertiary Hospital.

Abstract

Background: Micropenis in a child may not only be related to cosmesis but raise the suspicion of a disorder of sex development or endocrine conditions requiring urgent attention. The study aims to describe the clinical and laboratory profile of children referred for micropenis over a six-year period at the Lagos University Teaching Hospital (LUTH) and highlight challenges encountered in management of these children.

Methodology: This was a retrospective study. Case records of patients who were referred with complaints or diagnoses of "micropenis" from March 2018 to March 2024 were analysed. The Health Research and Ethics Committee of LUTH approved the study.

Results: Eighty-three children were referred for micropenis. On review, the stretched penile length (SPL) in 16 children (mean [SD]age of 8.9± 3.42 years) was within reference ranges and they were excluded from further evaluations. The remaining 67 children with confirmed micropenis constituted 12.4% of 541 new paediatric endocrine cases. The median age (range) at presentation was 9(0.7-16) years. Boys within the peripubertal age group constituted the majority of the patients. Co-morbidities included obesity, Down Syndrome, sickle cell anaemia, and growth hormone deficiency. Challenges in management included unaffordability of laboratory tests as only 21 children (31.3%) performed the human chorionic gonadotrophin (hCG) stimulation, our local testing, more than half (68.6%) could not carry out any investigations and age-appropriate/ preparations of testosterone were unavailable for treatment.

Conclusion: Micropenis constituted a sizeable proportion of the paediatric endocrine consultations in our setting. Accurate measurements are important to exclude unaffected children and prevent unnecessary expensive investigations. The National Health Insurance Services (NHIS) should be strengthened to enable patients to access necessary investigations and treatment related to micropenis. Licensing of age-appropriate drugs for treatment by relevant authorities is advocated.