Fig. 4.

Interpretation of the results of the human chorionic gonadotrophin (hCG) stimulation test when investigating XY DSD and pointers for consideration of prolonged hCG stimulation and adrenocorticotrophin hormone stimulation. ¹Prolonged hCG stimulation test should be considered in those cases where there is a poor testosterone (T) response to a standard hCG stimulation test. ²Synacthen stimulation test should be considered in those cases who show a poor testosterone response to hCG stimulation. 46,XY children with lipoid congenital adrenal hyperplasia due to a steroidogenic acute regulatory defect or P450scc deficiency due to CYP11A1 defect will have female genitalia and present in a salt-losing state in the first days or weeks of life before synacthen performed.