An unusual case of clitoral enlargement: its differential diagnosis and surgical management

Clitoromegaly can be either congenital or acquired. The congenital forms are caused by hormonal disturbances or intersex states. Usually they are obvious at birth. When the clitoromegaly develops later the underlying aetiology should be explored and acquired causes should also be considered. These acquired forms of clitoromegaly are either hormonal or non-hormonal. In the hormonal causes, an androgen excess is the main contributing factor of the clitoral enlargement. Three groups should be distinguished: endocrinopathies, masculizing tumours, or self-injection of long-acting synthetic androgens. The most important endocrinopathies are non-polycystic ovarian hypertenstosteronism and polycystic ovarian syndrome. The only reported non-hormonal cause has been neurofibromatosis. We present a case in which the clitoromegaly developed during puberty. As no hormonal disturbances or other abnormalities had been found, and no signs of neurofibromatosis seen, temporary use of steroids was suspected. To our surprise a large sebaceous cyst was found.