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A young boy with signs of puberty

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

A young boy with signs of puberty

  1. 1. Dr. Mashfiqul Hasan Resident, MD Phase A (EM)Discipline of Endocrine Medicine BSMMU
  2. 2.  Case summary Short discussion
  3. 3.  7 year Boy Only child of parents
  4. 4.  Appearance of pubic hair, facial hair Gradual enlargement of phallus Deepening of the voice  For 5-6 months
  5. 5.  No history of headache, visual disturbance or seizure. No significant past illness, no regular medication. No history of early onset puberty in family.
  6. 6.  Pubic hair : Slightly curled, dark, coarse, spread sparsely. Tanner stage of pubic hair: P3
  7. 7.  Testis: 15 ml on both sides, firm, symmetrical, smooth surface Stretched penile length: 12.5 cm Tanner stage of genitalia: G4
  8. 8. Height:143 cm
  9. 9.  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)
  10. 10.  Accelerated (>1 year)
  11. 11.  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)
  12. 12.  LH spike (>10 mIU/ml) after 30 minutes.
  13. 13.  No significant abnormality.
  14. 14.  Central idiopathic precocious puberty
  15. 15.  Inj. Decapeptyl (11.25 mg) 3 monthly Plan is to continue up to 11 years of age Now he is on regular follow up
  16. 16.  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
  17. 17. Central orGonadotropin dependent Peripheral orGonadotropin independent
  18. 18.  Short adult stature due to early epiphyseal fusion, Underlying pathology Adverse psychosocial outcomes
  19. 19.  Potential for  Evaluation of progression mechanism
  20. 20.  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
  21. 21.  Clinical Lab investigations ◦
  22. 22.  Family history Features of CNS lesion Testicular size Features of specific cause
  23. 23.  S. Testosterone/S. Estradiol S. LH, S. FSH GnRH stimulation test S. ß-hCG S. DHEAS S. 17-hydroxy Progesterone Thyroid function test
  24. 24.  Pelvic ultrasound Testicular ultrasound MRI of brain
  25. 25.  GnRH agonists ◦ Triptorelin (Decapeptyl) Management of CNS lesion
  26. 26.  Removal of the cause
  27. 27.  Social stigmata, psychosocial impact Clinical dilemma Rational approach
  28. 28. THANK YOU
  • ChristianRyan4

    May. 3, 2020
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    Jul. 17, 2018
  • shohelkhan8

    May. 10, 2018
  • MoushumiUrmi

    Jan. 23, 2018
  • AhmedSuadi

    Dec. 9, 2017
  • MINAHMOSEHLA

    Aug. 31, 2017
  • alexanderschnurr10

    Apr. 13, 2015

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

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