Endocrine Abstracts

Introduction: Central precocious puberty (CPP) is a frequent reason for consultation in pediatrics. It is defined as the development of sexual characteristics before the age of 8 years in girls and 9 years in boys. Pediatric pituitary adenomas are rare. We report the case of a patient who presented with central precocious puberty on pituitary adenoma.

Observation: This is a patient aged 7 years and 6 months, without any particular history, having consulted initially for a premature thelarche. Her history of the disease goes back to the age of 7 years by the development of mammary glands, appearance of pubic and axillary hair without metrorrhagia, with an acceleration of the statural growth rate. Moreover, she did not report any pituitary tumor syndrome, and she had a significant psychological impact. The clinical examination found: a weight: 38 kg (+3DS), a height: 1,42 m (+3DS), BMI: 18,8 kg/m², blood pressure: 120/60 mmhg, estimation of the pubertal stage: S3P3 and a dry vulva. The rest of the clinical examination was unremarkable. Pelvic ultrasound objectives a thin and median vacuity line, ovarian length ≥ 25 mm, body to neck ratio >1. Estradiol level :20 pg/ml. Bone age is 9 and ½ years (advanced by 2 years/chronological age). For etiological orientation : Inhibin B : 85 pg/ml, LH : 2.6 IU/l, FSH :6 IU/l, LHRH TEST : peak LH : 50 IU /l, LH/FSH ratio : 6. The diagnosis of central precocious puberty is confirmed. Hypothalamic-pituitary MRI shows a pituitary adenoma of 10*9 mm far from the optic chiasm. The fundus and the visual field did not show any abnormalities. The evaluation of the various endocrine axes is without particularity. Therapeutically, she was treated with GnRh agonists with a good clinical and biological evolution.

Discussion and conclusion: Central precocious puberty is frequent, the search for a tumoral etiology remains a priority. Pediatric pituitary adenomas are rare, representing 3% of all pediatric intracranial tumors and 5% of all pituitary adenomas. They are mainly functional tumors, more frequently secreting prolactin, ACTH, and growth hormone, while gonadotropin hypersecretion is very rare. 4 cases of PPC on pituitary adenoma have been reported in the literature: 2 cases secreting FSH alone and 2 cases secreting FSH and TSH. Treatment with GnRH analogues is indicated in the case of clinically, biologically and radiologically progressive PP, with an impact on adult height, and on the psychological level.