This case was first presented by me in Endocrinology department of BSMMU in 2011.

1. Dr. Mashfiqul Hasan
Resident, MD Phase A (EM)
Discipline of Endocrine Medicine
BSMMU

2.  Case summary
 Short discussion

4.  7 year
 Boy
 Only child of parents

5.  Appearance of pubic hair, facial hair
 Gradual enlargement of phallus
 Deepening of the voice
 For 5-6 months

6.  No history of headache, visual disturbance or
seizure.
 No significant past illness, no regular medication.
 No history of early onset puberty in family.

7.  Pubic hair :
Slightly
curled, dark,
coarse,
spread
sparsely.
 Tanner stage
of pubic
hair: P3

8.  Testis: 15 ml on
both sides, firm,
symmetrical,
smooth surface
 Stretched penile
length: 12.5 cm
 Tanner stage of
genitalia: G4

9. Height:
143 cm

10.  Current height : 143 cm
 Father’s height : 158 cm
 Mother’s height : 151 cm
 Expected adult height:
 So, the expected adult height is :
◦ ` 161 cm ( 10cm)

12.  Accelerated (>1 year)

13.  S. Testosterone 4.9 nmol/L
(0.1-1.0 nmol/l for 6-9 years)
 S. LH 2.27 IU/L
(0.01-0.78 nmol/l for 8-10 years)
 S. FSH 3.26 IU/L
(0.2–1.67 IU/L for 8-9 years)

14.  LH spike (>10 mIU/ml) after 30 minutes.

15.  No significant abnormality.

16.  Central idiopathic precocious
puberty

17.  Inj. Decapeptyl (11.25 mg) 3 monthly
 Plan is to continue up to 11 years of age
 Now he is on regular follow up

19.  Pulsatile secretion of gonadotropin-releasing
hormone (GnRH) and activation of the
hypothalamo–pituitary–gonadal axis
 Lower end of the normal range for the onset of
puberty:
◦ 8 years in girls and
◦ 9 years 6 months in boys

20. Central or
Gonadotropin dependent
Peripheral or
Gonadotropin independent

21.  Short adult stature due to early epiphyseal
fusion,
 Underlying pathology
 Adverse psychosocial outcomes

22.  Potential
for  Evaluation
of
progression mechanism

23.  50% of cases regress or stop progressing, and
no treatment is necessary
 Evaluation is needed when
◦ Progression through pubertal stages
◦ Growth velocity
◦ Bone age
◦ LH peak after GnRH agonist

24.  Clinical
 Lab investigations
◦

25.  Family history
 Features of CNS lesion
 Testicular size
 Features of specific cause

26.  S. Testosterone/S. Estradiol
 S. LH, S. FSH
 GnRH stimulation test
 S. ß-hCG
 S. DHEAS
 S. 17-hydroxy Progesterone
 Thyroid function test

27.  Pelvic ultrasound
 Testicular ultrasound
 MRI of brain

29.  GnRH agonists
◦ Triptorelin (Decapeptyl)
 Management of CNS lesion

30.  Removal of the cause

31.  Social stigmata, psychosocial
impact
 Clinical dilemma
 Rational approach

33. THANK YOU