Endocrine Abstracts

Background

In the pediatric population, the Leydig cell testicular tumor (TCL) is rare. It manifests communally in childhood with isosexual precocity gonadotropin-independent due to excess testosterone production.

Case report

We admitted a case of an 8.5 years old boy with the complaint of sexual precocity dating back to 4 years, which manifested by acne, hyper seborrhea, stature advance, penile enlargement, pubic hair development, and enlarged left testis. The testosterone level was 2.24 ng/ml. LH was 0.22 UI/l. Ultrasonography demonstrated a left testis increased in volume by presenting a well-limited central nodule of 20 mm, with scattered microcalcifications. An inguinal radical orchiectomy managed this mass. The pathological diagnosis was a benign Leydig cell tumor. Three months after surgery, the testosterone levels stayed high, facing an LH level of 3.26 UI/l.

Discussion and conclusion

The incidence of Leydig cell tumor is 1% of testicular neoplasms[1]. Its prognosis is not tumoral because they are benign in 90% of cases [2], but it has repercussions in terms of stature growth by accelerating the growth rate as they are associated with increased sex steroid production that caused the LH-independent precocious puberty like in our case. Radical orchiectomy was performed. Post-orchiectomy surveillance showed pubertal levels of gonadotropins, which are thought to be likely triggered by hypothalamic–pituitary axis activation due to long-term sex steroid exposure. Further explorations are in progress.

Keywords

precocious puberty, Leydig cell tumor, stature advance.

References

[1] Pomajzl AJ, Siref LE. Leydig Cell Cancer. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.

[2] Santos-Silva R, Bonito-Vítor A, Campos M, Fontoura M. Gonadotropin-dependent precocious puberty in an 8-year-old boy with leydig cell testicular tumor. Horm Res Paediatr. 2014;82(2):133–7.