Background: D was a 7 year old Caucasian female who presented with a history of adult-type body odour starting at age 3 years. At age 6y 9m her bone age was 7y 10m. She had had a sharp increase in her weight in the past 2 years and her PCP noticed pubic hair growth. Her very anxious single mother was convinced she had a serious illness that needed immediate intervention.
Case presentation: At presentation, D had Tanner 2 pubic hair and Tanner one breast development. BMI was >99%. Her complexion was clear. Her work-up showed no history of exogenous androgen exposure, but her mother was applying non-diluted lavender essential oil to her feet several times a day to help eliminate odour. Labs showed normal gonadotropin levels, thyroid, kidney and liver function. Her HCG tumour marker was 15 mlU/ml (normal <1). This lab was repeated with a result of 16.1 mlU/ml, then re-run using heterophile blocking reagent which was also elevated. Mother was advised to discontinue using any type of oil or other remedies of any kind throughout the duration of her testing. Abdominal ultrasound and brain MRI revealed no abnormal findings. Two weeks after the initial work-up, her HCG tumour marker was <0.6 mlU/ml.
Conclusion: Many patients are using complementary and alternative methods (CAM) of healing. A recent NIH study suggests that use of lavender oil may cause gynecomastia in males. There is no evidence suggesting lavender oil causes precocious puberty in females, yet a concerning lab finding returned to normal after our patient stopped using it. Although the research science is not available for many of the remedies being use, this case highlights the importance of exploring use of CAM methods during a work-up for endocrine issues. Parents should be cautioned accordingly.
01 Oct 2015 - 03 Oct 2015