Leydig Cell Tumor-Induced Gonadotropin-Independent Precocious Puberty Progressing to Gonadotropin-Dependent Precocious Puberty Post Orchiectomy: Out of the Frying Pan Into the Fire

Abstract

Many pathologies can cause gonadotropin-independent precocious puberty (GIPP) in prepubertal boys. Leydig cell tumor is one rare cause of this presentation. Here we present a six-year-old boy with features of isosexual precocious puberty, high testosterone levels, low gonadotropin levels, and bone age advancement. Testicular USG revealed a left-sided testicular tumor. The left testis was removed surgically, and the Leydig cell tumor was confirmed on histopathology. Post orchiectomy, the boy had elevated testosterone levels with raised luteinizing hormone (LH) levels. A diagnosis of gonadotropin-dependent precocious puberty (GDPP) was made. He has been initiated on monthly gonadotropin-releasing hormone (GnRH) agonist therapy.

Congenital adrenal hyperplasia complicated by gonadotropin-dependent precocious puberty

“…First, it appears that elevated sex steroids, rather than CAH itself, play a crucial role in causing GDPP. GDPP has also been documented in children with McCune-Albright syndrome, testotoxicosis, and virilising adrenal and testicular tumours 9–11. Second, there may be a correlation between the likelihood of developing GDPP in CAH and bone age.…”

Central Precocious Puberty Following Treatment of Precocious Pseudo-Puberty Caused by Leydig Cell Tumor: A Pediatric Case and Literature Review

“…These clinical features occur as a result of testosterone secretion without hypothalamic-pituitary activation. Most of the symptoms improve after surgical treatment, however, there are few cases that result in central precocious puberty after surgery [4][5][6][7][8][9][10][11].…”