Objectives The male reproductive axis is responsive to energetic deficits, including multi-day fasts, but little is known about brief periods of fasting (<24 hours). Reduced testosterone in low-energy balance situations is hypothesized to reflect redirection of resources from reproduction to survival. This study tests the hypothesis that testosterone levels decrease during a minor caloric deficiency by assessing the effects of a single missed (evening) meal on morning testosterone in 23 healthy male participants, age 19–36. Methods Participants provided daily saliva and urine samples for two baseline days and the morning following an evening fast (water only after 4PM). Testosterone, cortisol, and luteinizing hormone were measured with enzyme immunoassays. Results Fasting specimens had significantly lower overnight urinary luteinizing hormone (p=0.045) and morning salivary testosterone than baseline (p=0.037). In contrast to morning salivary testosterone, there was a significant increase in overnight urinary testosterone (p=0.000) following the evening fast, suggesting an increase in urinary clearance rates. There was a marginal increase in overnight urinary cortisol (p=0.100), but not morning salivary cortisol (p=0.589). Conclusion These results suggest the male reproductive axis may react more quickly to energetic imbalances than has been previously appreciated.

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Juvenile fibroadenoma is the most common breast mass in adolescents accounting for 0.5-4% of all cases of fibroadenomas. Giant fibroadenomas are well-circumscribed, firm breast masses characterized by proliferation of epithelial and connective tissue. They are defined as being larger than 5 cm or weighing more than 500 g. The peak age has been reported between the ages of 17 and 20, with less than 5% of these in patients less than 18-years-old.We present a 9-year-old, pre-menstrual, Nigerian female with no known family history of breast masses or cancers who developed spontaneous giant fibroadenoma measuring approximately 13  cm × 13 cm. Rapid growth of a breast mass can be of great concern to such young patients whose breasts are in the early formative stages. It is important to promptly rule out malignant processes or phyllodes tumor, and educate young patients and their families on treatment options that fit their unique concerns and circumstances.

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A 3-week-old, healthy, full-term, girl delivered via an uncomplicated vaginal delivery at home was referred by her pediatrician for evaluation of lesions on her face and scalp. She had had corneal lesions at birth. There had been no neurologic concerns to date.On physical examination, the lesion on her scalp was a 4.5-cm · 3.5-cm curvilinear, soft, pink, smooth alopecic plaque on the right scalp near the vertex, crossing the midline, extending onto her forehead, and terminating near her right eyebrow (Fig. 1). She had soft, smooth, alopecic, skin-colored to light pink circular plaques arranged in a linear configuration on her right temporal region with similar texture to the scalp lesion and several yellow to pink papules located on her right upper eyelid, right lateral canthus, and right cheek (Fig. 2). In each eye there was a pink telangiectatic plaque in a limbal distribution extending from the sclera to the cornea (Fig. 3). The remainder of her skin examination was unremarkable.