Precocious Pseudopuberty With Testicular Enlargement - medIND

Clinical Brief
Precocious Pseudopuberty With Testicular Enlargement
R. Rajput, A. Bhansali, R. Bhat and R. Sialy
Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Abstract. Gonadotropins independent precocious puberty (GIPP) in male is characterized by early appearance of sexual hairs
and phallic growth but without testicular enlargement. We report a case of GIPP with testicular enlargement who was diagnosed
to have testotoxicosis and successfully managed with spironolactone. [Indian J Pediatr 2006; 73 (4) : 356-358]
E-mail : anilbhansali_endocrine@rediffmail.com
Key words : Precocious pseudopuberty; Testotoxicosis
Puberty is the process of physical maturation manifested
by an increase in growth rate and appearance of
secondary sexual characteristics. Puberty is said to be
precocious if it occurs in boys younger than 9 years of age,
while in girls, less than 7 years of age, and in African
American girls younger than 6 years of age. 1 Precocious
puberty can be divided into two categories. The first
category is gonadotropins dependent precocious puberty
(GDPP) or true precocious puberty, which involves the
premature activation of hypothalamic-pituitary-gonadal
axis and characterized by appearance of axillary and
pubic hairs along with testicular enlargement. The second
category is gonadotropins independent precocious
puberty (GIPP) or precocious pseudopuberty in which the
increase in sex steroids is independent of pituitary
gonadotropins release, and axillary and pubic hairs
appear along with phallic enlargement but without
associated testicular enlargement.
We describe a case of a five and a half year old boy
who presented with precocious pseudopuberty with
testicular enlargement.
Correspondence and Reprint requests : Dr. Anil Bhansali,
Department of Endocrinology, Postgraduate Institute of Medical,
Education and Research, Chandigarh- 160012, India. Fax : 91-172-
744401, 745078
1, 2
CASE REPORT
A five and a half-year-old boy presented with progressive
phallic enlargement, development of axillary and pubic
hairs, aggressive behavior and rapid increase in height
over the last two years. The child was born of a nonconsanguineous
marriage and had no family history of
precocious puberty. He had no history of central nervous
system infections, head injury, neoplasm or prior
radiation and exposure to exogenous sex steroids. On
examination, his height was 128 cm (90 th percentile) and
weight was 23.4 kg, with target height of 165.3cm. He had
no café-au-lait spots and bony swellings. Systemic
examination was unremarkable. Genital examination
revealed a stretched penile length (SPL) of 6 cm and
testicular volume of 6 ml bilaterally (Prader’s orchidometer).
Both testes were firm, symmetrical and nontender
(Fig 1). Axillary and pubic hairs were Tanner stage
2 and had no gynecomastia. Investigations revealed a
Fig. 1. Showing clinical profile of the patient.
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bone age of 10 years. Basal serum lentiaisling hormone
(LH) was

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