Primary cortisol resistance presenting as isosexual precocity

Carl D. Malchoff, Emmanuel C. Javier, Diana M. Malchoff, Thomas Martin, Alan Rogol, David Brandon, D. Lynn Loriaux, George E. Reardon

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


Primary cortisol resistance (PCR) is a rare cause of hypercortisolism and usually does not produce clinical manifestations. This report describes primary cortisol resistance in a boy with isosexual precocity. A 67/12-yr-old boy had Tanner stage 3 pubic hair, accelerated linear growth, and advanced bone age (10 yr), but normal (for age) testes. There were no features of glucocorticoid excess. Serum androstenedione and dehydroepiandrosterone concentrations were 4.7 ± 0.3 nmol/L (mean ± SEM of four measurements; normal < 1.2) and 13.5 nmol/L (single measurement; normal, 1.0-2.2), respectively. The serum testosterone concentration was 0.9 nmol/L (normal, <0.7), and FSH and LH were normal. Serum cortisol concentrations were 1590 ± 110 nmol/L (normal, 190-630) and 580 ± 60 nmol/L (normal, 50-410) at 0800 and 2000 h, respectively. Serum cortisol responded normally to in-sulin-induced hypoglycemia. Glucocorticoids and adrenal androgens were resistant to suppression by dexamethasone. The Kd of [3H]dexamethasone binding to the glueocorticoid receptors of mononuclear leukocytes was increased (6.4 ± 0.8 nM; mean ± SEM of four determinations; normal, 1.4-3.4; P < 0.001), but the binding capacity was normal. This patient with isosexual precocity has PCR, as indicated by functionally abnormal glucocorticoid receptors and hypercortisolism without other clinical or biochemical manifestations of Cushing's syndrome. Excessive adrenal stimulation by ACTH caused increased secretion of both cortisol and adrenal androgens, and the latter caused the clinical manifestations. PCR should be considered in other male children with isosexual precocity or female children with heterosexual precocity.

Original languageEnglish (US)
Pages (from-to)503-507
Number of pages5
JournalJournal of Clinical Endocrinology and Metabolism
Issue number2
StatePublished - 1990
Externally publishedYes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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