This case discusses a 7-year-old boy presenting with early signs of puberty over the past 5-6 months. Laboratory tests showed elevated levels of testosterone, LH, and FSH, confirming precocious puberty. A GnRH stimulation test showed an LH spike, indicating central precocious puberty. The patient was diagnosed with idiopathic central precocious puberty and prescribed injections of Decapeptyl to delay further pubertal progression until age 11 in order to avoid short adult stature. The document discusses evaluation and management of precocious puberty.

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